Incidence of bariatric surgery and postoperative outcomes: a population‐based analysis in Western Australia

Abstract

Objective: To investigate the incidence of bariatric surgery and postoperative outcomes in a population‐based cohort of patients in Western Australia over a 17‐year period. Design and setting: A population‐based incidence study of all bariatric procedures (n = 1403) performed in WA hospitals over the period 1988–2004, based on hospital morbidity and death data from the WA Data Linkage System. Main outcome measures: Changes in incidence of bariatric procedures over time; mortality and complications within 30 days after surgery; survival rates after surgery relative to age‐, sex‐, and period‐matched survival rates in the general population; factors predictive of re‐admission to hospital. Results: The incidence of bariatric surgery increased from 1.2 procedures per 100 000 person‐years in 1988 to 24.2 procedures per 100 000 person‐years in 2004. Although some of this was ascribed to a rising prevalence of obesity generally, there was a 13‐fold increase in the bariatric procedure rate within the obese population itself. At 5 years, the relative survival rate in bariatric patients was the same as the survival rate in the general population. Within the 30‐day postoperative period, mortality was low (0.07%) and 9.6% of patients experienced complications. Those who had bypass‐type procedures were more likely to be re‐admitted within 30 days than those who had gastric reduction procedures (adjusted hazard ratio, 5.80 [95% CI, 3.42–9.84]). Conclusion: The use of bariatric surgery increased 20‐fold over the study period. Relative survival after surgery was in line with population norms. The observed low mortality rates and moderate level of complications are similar to findings in other studies in which the proportion of reduction procedures has been high.

Incidence and outcomes after bariatric surgery in older patients: a state‐wide data‐linked cohort study

“…Bariatric surgery has matured into a distinct surgical discipline over the last two decades with an abundance of large population‐based studies demonstrating its safety and effectiveness as a treatment for obesity . Despite this, bariatric surgery has largely remained the domain of younger patients with most publications consistently reporting mean ages below 45 years . However, it is the older age groups with the greatest prevalence of obesity and obesity‐related comorbidities that stand to potentially benefit the most from effective weight loss treatments where there exists a reluctance in the uptake of bariatric surgery.…”

“…It brings together eight core data elements (birth records, midwives’ notifications, cancer registrations, inpatient hospital morbidity, inpatient and public outpatient mental health services data, death records, emergency department data collection and the Western Australian electoral roll). The accuracy of this database has been previously validated and formed the basis of several large, published population‐based studies . Prior approvals from our local institution and the Western Australian Department of Health Human Research Ethics Committee were granted before the release of de‐identified data in a format using 10th edition international classification of diseases (ICD‐10) diagnostic and procedure codes.…”

“…Furthermore, weight gain increases with age peaking amongst Australians 55–64 years old (36.7% with BMI ≥30 kg/m 2 in 2012) . Attempts to curtail escalating obesity rates have seen a dramatic rise in the popularity of bariatric surgery over the last two decades . Rapid increases in the incidence of bariatric surgery have been matched by improved surgical and anaesthetic methods with a well‐established evidence base supporting its safety and efficiency in providing a viable long‐term solution to obesity .…”

“…Likewise, beneficial weight loss is attainable within 12 months of surgery, allowing older patients to realize effective changes to their quality of life in an achievable time frame . Despite this, the mean age of bariatric surgery in Australia has previously been reported at 41.5 years . Concerns regarding increased peri‐operative complications rates coupled with private Australian hospitals not always offering the required multidisciplinary resources, such as intensive care, have led to a reluctance in offering bariatric surgery to older patients.…”

Oesophagectomy rates and post-resection outcomes in patients with cancer of the oesophagus and gastro-oesophageal junction: a population-based study using linked health administrative linked data

“…However, despite being the only curative treatment for oesophageal/gastro-oesophageal cancer patients, oesophagectomy is associated with significant operative morbidity and mortality [5-7]. Key performance measures of oesophagectomy include 30-day mortality, hospital length-of-stay and post-surgery complication rate [8-17]. Factors influencing outcomes following oesophagectomy include hospital/surgeon factors (peer group/volume, surgical experience), tumour stage, histology and location, surgery type and patient comorbidity; with better outcomes reported in high volume hospitals, patients with non-metastatic disease (approximately 60% of patients), adenocarcinoma (the incidence of which is increasing), and when transhiatal oesophagectomy is performed [18-25].…”