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Outcomes and experiences of Indigenous patients in Newfoundland and Labrador's bariatric surgery program: a pilot
Intekhab Hossain1, Erin O'Brien2, Ibrahim Dogar2
1From the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Hossain, Dubinsky); the Department of Surgery, University of Toronto, Toronto, Ont. (Hossain); the Department of Surgery, Memorial University of Newfoundland, St. John's, N.L. (O'Brien, Dogar, Pace, Smith) Intekhab.Hossain@uhn.ca.
Background:
Indigenous Peoples in Canada have higher obesity rates (30%-51%) than non-Indigenous populations (12%-31%), and the Truth and Reconciliation Commission of Canada (TRC) has called for expanded health research to address disparities between Indigenous and non-Indigenous communities. We sought to compare bariatric surgery outcomes and patient experiences in Newfoundland and Labrador's bariatric surgery program among Indigenous versus non-Indigenous patients.
Methods:
We conducted a mixed-methods retrospective cohort study, including patients who underwent bariatric surgery in the province's bariatric surgery program between 2011 and 2022. We assessed metabolic outcomes through chart review and captured patient experiences with phone survey questionnaires.
Results:
Among the 30 included patients (8 Indigenous, 22 non-Indigenous), there were no significant differences in excess weight loss (45% v. 48%, p = 0.4), reduction in body mass index (9.5 v. 11.3, p = 0.2), comorbidity improvement (63% v. 73%, p = 0.6), or postoperative complications (25% v. 18%, p = 0.6) at 1 year. However, on a 1-10 Likert scale, Indigenous patients reported lower satisfaction with weight loss (6.3 v. 8.2, p = 0.03) and were less likely to recommend the program (5.6 v. 8.8, p = 0.04). Both groups cited similar challenges with program referral, transportation, and postoperative supports, and recommended a longer follow-up period and increased mental health counselling services.
Conclusion:
As a response to TRC's Calls to Action, our study shows bariatric surgery outcomes in Newfoundland and Labrador were similar for Indigenous and non-Indigenous patients. Given their lower satisfaction with postoperative decrease in weight, Indigenous patients may benefit from being offered metabolic procedures with greater expected weight loss, such as Roux-en-Y gastric bypass and duodenal switch.
