Oral Presentation Australian & New Zealand Obesity Society 2014 Annual Scientific Meeting

Does bariatric surgery work in public hospitals? (#84)

Natalie Lukas 1 , Janet Franklin 2 , Crystal Lee 3 , Craig Taylor 4 , David Martin 4 , Nic Kormas 5 , Ian Caterson 3 , Tania Markovic 2
  1. Royal North Shore Hospital, Sydney, NSW, Australia
  2. Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, NSW, Australia
  4. Department of Surgery, Concord Repatriatrion General Hospital, Sydney, NSW, Australia
  5. Department of Endocrinology, Concord Repatriation General Hospital, Sydney, NSW, Australia

The aim of this study was to determine the efficacy of bariatric surgery in the public sector for the treatment of complicated obesity.

Methods: A longitudinal observational study of obese participants with co-morbidities, aged 21-73 years, who underwent publicly-funded bariatric surgery was performed. Data was extracted from clinical databases (from October 2009 through September 2013) and recorded at seven time points. Participants are from an ongoing public obesity management programme.

Results: The mean weight loss of 65 participants in the cohort was 22.6 kg (SD, 9.5 kg) by 3 months, 35.4.kg (SD, 20.1 kg) by 12 months and 38.9 kg (SD, 21.9 kg) by 24 months (P < 0.001). Body mass index (BMI) decreased from a preoperative mean of 48.2 kg/m2 (SD, 9.5 kg/m2) to 35.7 kg/m2 (SD, 7.7 kg/m2) by 24 months (P < 0.001). Full resolution of comorbid conditions by 18 months (P < 0.001) was achieved by almost half of those who had T2DM at baseline (11/23), nearly two thirds of those with HTN (17/27) and three quarters of those with OSA (18/24), with continued improvements observed beyond 24 months. Two of the 65 laparoscopic procedures performed required revision after 18 months and six other subjects experienced mild complications, all of which had resolved by 12 months.

Conclusions: Bariatric surgery performed publicly is efficacious in the treatment of obese subjects with co-morbidities. Our findings parallel similar studies, suggesting that there is equal benefit in publicly-funded and privately-performed procedures. This study highlights that obese patients reliant on public healthcare maintain sufficient intrinsic motivation in the absence of payment and supposed value-driven incentive. Improved access to bariatric surgery publicly can justifiably reduce the health inequities for those most in need.