Outcomes of high-volume bariatric surgery in the public system

Bariatric surgery has not been widely used in the Australian public health system. As obesity is strongly associated with socio-economic status, excluding its use from the public system will deny many of the most in-need access to a potentially very effective treatment. Alternatively, with rigorous follow-up and behavioural change requirements, highly successful outcomes in the private system may not translate to the public system.

The Alfred Hospital rapidly expanded bariatric surgery from 2007. A 6-year prospective follow-up study was conducted with annual review of weight, co-morbidities, retention in follow-up, serum HbA1c, quality of life and patient satisfaction.

There were 1453 patients. Procedures were predominantly laparoscopic-adjustable gastric bands (n = 861). Patient details were age 49 ± 11 years, body mass index 50.7 ± 11.2 kg/m(2) and weight 139.0 ± 30.2 kg. There was no mortality, and mean length of stay was 1.1 ± 1.2 days. Follow-up was 98% (1 year) and 85% (6 years). Weight loss was 22 ± 13.1 kg (32.8 ± 18% excess weight loss) at 1 and 30.1 ± 16.8 kg (60 ± 28%) at 6 years. The mean number of co-morbidities was 4.2 ± 1.1 with significant improvements observed. Patient satisfaction was 7.7 ± 2.3 out of 10. Mental and physical summary scores (SF-36) improved from 41.02 ± 13.17 to 45.50 ± 13.27 (P < 0.001) and 33.97 ± 10.53 to 44.79 ± 11.19 (P < 0.001).

Patients were older, heavier and suffered more co-morbid disease than previously reported cohorts. For the first time, excellent outcomes across a range of key quality domains in a large patient cohort have been reported in the public system. High-volume bariatric surgery in the public system is viable.