Skip to main content

Advertisement

SpringerLink
Log in

Variability in Bariatric Surgical Care Among Various Centers: a Survey of All Bariatric Surgeons in the Province of Quebec, Canada

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Despite an increase in bariatric surgery across Quebec, Canada, access is still limited. Furthermore, there are differences in resources and multidisciplinary capabilities of providing centers that may impact quality of care and outcomes.

Methods

We performed an online survey of all bariatric surgeons in the province of Quebec, Canada, using the LimeSurvey software.

Results

Forty-six surgeons from 15 centers were surveyed. Response rate was 87% (n = 40). Only 13 (35%) surgeons have any formal fellowship training in bariatric surgery and 74% perform > 50 cases/year. All surgeons perform sleeve gastrectomy, 34% do duodenal switch, and 44% provide major revisions. Thirty-one surgeons (77%) identified access to operating room as the main cause for surgical delays. While most surgeons (52%) considered < 6 months as an acceptable wait-time, only 33% achieved this in their practice. Majority (70%) favored a centralized provincial referral system. Patient’s geographical convenience, procedural choice, and multidisciplinary capabilities of providing centers are identified as important determinants for centralized referrals (93, 78, and 55%, respectively). Virtually, all supported accreditation/designation of centers and creation of Quebec Bariatric Network for quality control and research (85 and 98%, respectively).

Conclusion

Bariatric surgical patterns vary among designated centers in Quebec, Canada. Access to multidisciplinary care and surgeon’s fellowship training may be contributing factors for the observed variability. Wait-lists are long and timely access to surgery remains an issue. There is near consensus for establishing a centralized referral system, designation of referral vs. primary centers, and creating Quebec Bariatric Network for research and quality control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Navaneelan T, Janz T. Adjusting the scales: obesity in the Canadian population after correcting for respondent bias. Statistics Canada. May 2014; catalogue no. 82-624-X. Health at a Glance

  2. Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.

    Article  Google Scholar 

  3. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration, Lu Y, Hajifathalian K, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2014;383(9921):970–83.

    Article  Google Scholar 

  4. Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.

    Article  PubMed  Google Scholar 

  5. Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg. 2007;17(5):601–7.

    Article  PubMed  Google Scholar 

  6. Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32(Suppl 7):S93–7.

    Article  Google Scholar 

  7. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23. discussion 23-4

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bariatric Surgery in Canada. Canadian Institute for Health Information. 2015. Available at: https://www.cihi.ca/en/bariatric-surgery-in-canada-infographic. Accessed 01 Dec 2017.

  9. Canadian Obesity Network-Réseau canadien en obésité. Report Card on Access to Obesity Treatment for Adults in Canada 2017. Canadian Obesity Network Inc 2017. Available at: http://www.obesitynetwork.ca/files/FULLREPORTfinalENG.pdf. Accessed 01 Dec 2017.

  10. L’organisation de la chirurgie bariatrique au Québec: Plan d’action. La Direction des communications du ministère de la Santé et des Services sociaux du Québec. 2009. Available at: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2009/09-932-01.pdf. Accessed 01 Dec 2017.

  11. Ontario Bariatric Network: Surgical program. 2015. Available at: http://www.ontariobariatricnetwork.ca/our-programs/surgical-program. Accessed 01 Dec 2017.

  12. Abraham A, Ikramuddin S, Jahansouz C, et al. Trends in bariatric surgery: procedure selection, Revisional surgeries, and readmissions. Obes Surg. 2016;26(7):1371–7.

    Article  PubMed  Google Scholar 

  13. Khorgami Z, Shoar S, Andalib A, et al. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;13(5):774–8.

    Article  PubMed  Google Scholar 

  14. Sanchez-Pernaute A, Herrera MA, Perez-Aguirre ME, et al. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010;20(12):1720–6.

    Article  PubMed  Google Scholar 

  15. Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3(1):29–35.

    Article  PubMed  CAS  Google Scholar 

  16. Doumouras AG, Saleh F, Anvari S, et al. The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada. Surg Endosc. 2017;31(11):4816–23.

    Article  PubMed  Google Scholar 

  17. Ali MR, Tichansky DS, Kothari SN, et al. Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–44.

    Article  PubMed  Google Scholar 

  18. Agrawal S. Impact of bariatric fellowship training on perioperative outcomes for laparoscopic roux-en-Y gastric bypass in the first year as consultant surgeon. Obes Surg. 2011;21(12):1817–21.

    Article  PubMed  Google Scholar 

  19. Aminian A, Chaudhry RM, Khorgami Z, et al. A challenge between trainee education and patient safety: does fellow participation impact postoperative outcomes following bariatric surgery? Obes Surg. 2016;26(9):1999–2005.

    Article  PubMed  Google Scholar 

  20. Jafari MD, Jafari F, Young MT, et al. Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surg Endosc. 2013;27(12):4539–46.

    Article  PubMed  Google Scholar 

  21. Gebhart A, Young M, Phelan M, et al. Impact of accreditation in bariatric surgery. Surg Obes Relat Dis. 2014;10(5):767–73.

    Article  PubMed  Google Scholar 

  22. Azagury D, Morton JM. Bariatric surgery outcomes in US accredited vs non-accredited centers: a systematic review. J Am Coll Surg. 2016;223(3):469–77.

    Article  PubMed  Google Scholar 

  23. Ibrahim AM, Ghaferi AA, Thumma JR, et al. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. 2017;152(7):629–36.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Access to specialized medical services-Bariatric surgery. 2018. Available at: http://wpp01.msss.gouv.qc.ca/appl/g74web/carte.asp. Accessed January 25, 2018.

  25. Saleh F, Doumouras AG, Gmora S, et al. Outcomes the Ontario bariatric network: a cohort study. CMAJ Open. 2016;4(3):E383–E9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Elnahas A, Jackson TD, Okrainec A, et al. The effect of the Ontario bariatric network on health services utilization after bariatric surgery: a retrospective cohort study. CMAJ OpenS. 2016;4(3):E489–E95.

    Article  Google Scholar 

  27. Aird LN, Hong D, Gmora S, et al. The impact of a standardized program on short and long-term outcomes in bariatric surgery. Surg Endosc. 2017;31(2):801–8.

    Article  PubMed  Google Scholar 

  28. Sharma AM. Inequalities in access to bariatric surgery in Canada. CMAJ. 2016;188(5):317–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Doumouras AG, Anvari S, Breau R, et al. The effect of an online referral system on referrals to bariatric surgery. Surg Endosc. 2017;31(12):5127–34.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was accepted for a poster presentation during the Canadian Association of Bariatric Physicians and Surgeons (CABPS) 2017 meeting, in Niagara Falls, ON, Canada.

Author information

Authors and Affiliations

  1. Center for Bariatric Surgery, Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada

    Amin Andalib, Philippe Bouchard, Alexandre Bougie, Sarah-Eve Loiselle, Sebastian Demyttenaere & Olivier Court

  2. Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, Room: E16-152, Montreal, QC, H3G 1A4, Canada

    Amin Andalib

Authors
  1. Amin Andalib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Bouchard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Bougie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah-Eve Loiselle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Demyttenaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier Court
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amin Andalib.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andalib, A., Bouchard, P., Bougie, A. et al. Variability in Bariatric Surgical Care Among Various Centers: a Survey of All Bariatric Surgeons in the Province of Quebec, Canada. OBES SURG 28, 2327–2332 (2018). https://doi.org/10.1007/s11695-018-3157-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3157-4

Keywords

Search

Navigation