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Does the National Bariatric Prioritization Tool predict health outcomes?
Lisa Chung1, Gajan Srikumar1, Christin Coomarasamy2
1Department of General Surgery, Middlemore Hospital, Te Whatu Ora Counties Manukau, Auckland, New Zealand.
ANZ Journal of Surgery
|August 22, 2023
Summary
The National Bariatric Prioritization Tool (NBPT) did not predict weight loss but showed promise in improving comorbidities like diabetes and hypertension. Higher scores for Māori and Pasifika suggest potential for equitable access in bariatric surgery prioritization.
Area of Science:
- Bariatric Surgery Outcomes
- Health Equity Research
- Clinical Prioritization Tools
Background:
- The National Bariatric Prioritization Tool (NBPT) was developed in Aotearoa New Zealand but lacked validation with real-world patient data.
- The study aimed to assess the predictive validity of the NBPT on various health outcomes in patients undergoing bariatric surgery.
Purpose of the Study:
- To evaluate the NBPT's predictive accuracy for percentage total weight loss (%TWL) 18 months post-surgery.
- To determine the correlation between NBPT scores and improvements in key health indicators, including HbA1c, lipids, obstructive sleep apnea (OSA), hypertension, and arthritis medication use.
- To assess the equity of access by examining the relationship between NBPT scores and demographic factors such as age, gender, and ethnicity.
Main Methods:
- An observational study included 294 consecutive patients undergoing elective bariatric surgery between December 2014 and December 2016.
- The NBPT was used for prioritization, and data on %TWL, HbA1c, lipids, OSA resolution, hypertension resolution, and medication use were collected at 18-month follow-up.
- Statistical analyses were performed to correlate NBPT scores with health outcomes and demographic data.
Main Results:
- No significant correlation was found between the NBPT prioritization score and %TWL (correlation -0.09, P=0.14).
- A positive correlation was observed between the 'benefit score' component of the tool and %TWL (correlation 0.25, P<0.0001).
- Significant correlations were identified between the prioritization score and improvements in HbA1c (0.28), OSA resolution (0.20), and hypertension resolution (0.20).
- Māori and Pasifika patients had significantly higher NBPT scores compared to New Zealand Europeans (P=0.0023), indicating potential ethnic disparities in prioritization.
Conclusions:
- The NBPT may not be a reliable predictor of %TWL but shows potential predictive validity for improving comorbidities such as diabetes, OSA, and hypertension.
- Higher NBPT scores among Māori and Pasifika populations, who experience higher rates of obesity and comorbidities, suggest the tool could be utilized to promote equitable access to bariatric surgery.
- Further refinement of the NBPT is recommended to enhance its ability to predict outcomes and ensure equitable patient selection.
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