Time Trends in Obesity Surgery 1987 through 1996 in Sweden — A Population-Based Study

Background:The Swedish health-care system is well suited for surveys of incidence of surgical procedures including those for morbid obesity, since almost all hospital care is provided by public hospitals funded by a public health-care insurance system.The National Board of Health andWelfare keeps a nation-wide registry of all in-patient hospital care. In order to describe the practice of obesity surgery, we extracted data for all patients who had undergone obesity surgery between 1987 and 1996. Material: 6,339 patients had at least one obesity surgery procedure between Jan. 1987 and Dec. 1996. A total of 7,176 procedures were identified. 77.2% were women, and the mean age was 39 years. Hospital stay averaged 8 days. Results:There was a 3-fold increase in the annual incidence from 312 procedures/year in 1987 to 952 in 1996. 14% of the patients operated in1996 had previously undergone obesity surgery during the study period.The hospital mortality was 0.4%. Simple gastric restrictive procedures dominated (76%), and gastric bypass and jejuno-ileal bypass were performed in 7.5% and 5%, respectively. There was a trend that gastric bypass was performed more frequently towards the end of the study period. An increased number of procedures were performed in smaller hospitals during 1994-96, and there were obvious geographical variations. Conclusion:There has been 3-fold increase in obesity surgery in Sweden between 1987 and 1996, accounted for by increased performance of simple gastric restrictive procedures. The operative mortality is low, but the incidence of a second obesity surgery procedure is high.