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Status of the Field of Bariatric Surgery: a National Survey of China in 2018

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Abstract

Background

Due to the slow development of bariatric surgery in mainland China, we aimed to provide fact-based status reports and recommendations for the development of bariatric surgery in mainland China by investigating the basic context, social environment, and perioperative treatment options of surgeons who perform bariatric surgery.

Study Design

A questionnaire was prepared based on a literature review, consultations with experts and current issues. The three-part questionnaire was sent to medical professionals in the field of bariatric surgery. The results were gathered, and analysis was performed after collecting the data.

Results

In total, 98.5% of respondents were employed at public grade 3 class A hospitals, 70.8% were chief physicians and professors, 53.2% were trained at other institutions before their first bariatric surgery, 65.0% were previously engaged in gastrointestinal surgery, 76.9% were currently engaged in multiple fields of general surgery, 39.5% believed that low self-acceptance was the primary obstacle, 39.0% regarded news media networks as the most valued publicity platform, 48.0% accepted patients less than 16 years old, and 46.0% accepted patients greater than 65 years old. Additionally, 84.6% of respondents addressed comorbidities, 73.4% developed exercise guidance for patients, 81.6% believed that the total hospitalization cost was greater than 50,000 (CNY), 41.5% chose oral purgative for bowel preparation, 40.0% allowed patients to resume oral intake of liquids on the first day after surgery, and 70.7% routinely placed an abdominal drainage tube.

Conclusion

Bariatric surgery has great potential in mainland China, but many inconsistencies exist. This field is still in its infancy, and much work is needed.

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Acknowledgments

The authors acknowledge the Surgery Branch of the Chinese Medical Association and The Chinese Society for Metabolic & Bariatric Surgery.

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Authors and Affiliations

  1. Department of General Surgery, Fourth Affiliated Hospital of China Medical University, No. 4, Chongshan East Road, Huanggu District, Shenyang, 110032, Liaoning, China

    Keyu Yang, Yong Zhou, Mofei Wang, Mingyang Shen, Xiaowei Zhang & Yong Wang

Authors
  1. Keyu Yang
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  2. Yong Zhou
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  3. Mofei Wang
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  4. Mingyang Shen
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  5. Xiaowei Zhang
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  6. Yong Wang
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Corresponding author

Correspondence to Yong Wang.

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Conflict of Interest

I have not received payment or services from a third party for any aspect of the submitted work at any time. I have no financial relationships with others. I have no patents. Concerning conflicts of interest, the submitted work could not influence or potentially influence readers. There are no other relationships/conditions/circumstances that present a potential conflict of interest.

Ethical Approval Statement

This is a retrospective study. For this type of study, formal consent is not required.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

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Appendix Sample of the Questionnaire

Appendix Sample of the Questionnaire

Survey of the field of bariatric surgery

S/N

Part 1 (1–10) Part 2(11–20) Part 3(21–30)

1

Your gender is: A. male; B. female

2

Your age range is: A. ≤ 30; B. 31–39; C. 40–50; D. ≥ 50

3

Your professional title is: A. chief physician; B. deputy chief physician

C. attending physician D. physician

4

What was your surgery department before performing bariatric surgery:

A. thyroid/galactophore/hernia surgery department; B. gastrointestinal surgery department; C. hepatobiliary surgery department; D. other department

5

Do you engage only in the field of bariatric surgery now: A. yes; B. no

6

What training did you receive before your first bariatric surgery? A. surgery videos; B. visited other institutions for surgical training (face-to-face); C. network courses; D. other forms of learning

7

What do you think is the biggest resistance for obese people to accept bariatric surgery? A. low self-acceptance; B. high cost and the low proportion of insurance; C. family reasons; D. social environmental factor

8

The type of your hospital is: A. public grade 3 class A hospital; B. public grade 2 class A hospital; C. public grade 1 class A hospital; D. private hospital

9

The location of your hospital: A. Northeast China; B. East China; C. North China; D. Central China; E. South China; F. Southwest China; G. Northwest China

10

What is the most effective publicity strategy? A. networks and new media; B. reputation; C. newspaper/advertisement; D. radio E. television

11

Your bariatric surgery history is: A. less than 2 years; B. 3–5 years; C. 6–8 years; D. 9–11 years; E. more than 12 years

12

Do you actively promote other weight loss programs? A. yes; B. no

13

The number of bariatric surgeries you perform per year? A. less than 50 cases; B. 50–100 cases; C. 100–150 cases; D. 150–200 cases; E. more than 200 cases

14

The minimum age for patients undergoing bariatric surgery: A. younger than 14 years old; B. 15–16 years old; C. 17–18 years old; D. 19–20 years old; E. more than 21 years old

15

The maximum age for patients undergoing bariatric surgery: A. younger than 62 years old; B. 62–63 years old; C. 64–65 years old; D. 66–67 years old; E. more than 67 years old

16

Would you build an MDT? A. yes; B. no

17

Do you communicate with the anesthesiologist before surgery? A. yes; B. no

18

When a patient who undergoes bariatric surgery also has other diseases, would you treat these diseases together during the operation? A. yes; B. no

19

Would you recommend your patients for plastic surgery after bariatric surgery? A. yes; B. no

20

When a patient had indications for multiple surgical methods, you choose: A. laparoscopic sleeve gastrectomy; B. laparoscopic gastric bypass; C. follow the patient’s wishes in developing a surgical plan; D. other

21

Would you develop exercise guidance for patients after surgery? A. yes; B. no

22

What are the hospitalization expenses for your surgery patients? A. less than 40,000 (CNY); B. 40,000–50,000 (CNY); C. 50,000–60,000 (CNY); D. more than 60,000 (CNY)

23

What is the hospitalization time for your surgery patients? A. less than 4 days; B. 4–6 days; C. 6–8 days; D. greater than 8 days

24

Incidence of severe anemia after bariatric surgery: A. less than 2.0%; B. between 3.0 and 5.0%; C. between 6.0 and 8.0%; D. greater than 9.0%

25

When a patient’s BMI is greater than 55 kg/m2, what kind of bariatric surgery would you choose? A. laparoscopic sleeve gastrectomy; B. laparoscopic gastric bypass; C. laparoscopic sleeve gastrectomy followed by laparoscopic gastric bypass; D. other approaches

26

For a bariatric surgery, would bowel preparation be administered? A. no; B. yes, oral purgative; C. yes, enema; D. yes, both; E. according to the operative methods

27

For a bariatric surgery, would a nasogastric decompression tube routinely be placed? A. yes; B. no

28

When would patients be allowed to resume oral intake of liquids? A. operative day (6 h after the operation); B. postoperative day 1; C. postoperative day 2; D. at passage of gas; E. at bowel sounds

29

For a bariatric surgery, would an abdominal drainage tube routinely be placed? A. yes; B. no; C. according to the operative methods; D. according to the intraoperative situation

30

When would patients be allowed to become ambulatory after the operation? A. operation day (6 h after the operation); B. postoperative day 1; C. postoperative day 2

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Yang, K., Zhou, Y., Wang, M. et al. Status of the Field of Bariatric Surgery: a National Survey of China in 2018. OBES SURG 29, 1911–1921 (2019). https://doi.org/10.1007/s11695-019-03792-w

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