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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Doumouras AG, Lovrics O, Paterson JM, Sutradhar R, Paszat L, Sivapathasundaram B, Tarride JE, Anvari M. Residual Risk of Breast Cancer After Bariatric Surgery. JAMA Surg 2023; 158:634-641. [PMID: 37043196 PMCID: PMC10099105 DOI: 10.1001/jamasurg.2023.0530] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/04/2022] [Indexed: 04/13/2023]
Abstract
Importance Excess adiposity confers higher risk of breast cancer for women. For women who have lost substantial weight, it is unclear whether previous obesity confers residual increased baseline risk of breast cancer compared with peers without obesity. Objectives To determine whether there is a residual risk of breast cancer due to prior obesity among patients who undergo bariatric surgery. Design, Setting, and Participants Retrospective matched cohort study of 69 260 women with index date between January 1, 2010, and December 31, 2016. Patients were followed up for 5 years after bariatric surgery or index date. Population-based clinical and administrative data from multiple databases in Ontario, Canada, were used to match a cohort of women who underwent bariatric surgery for obesity (baseline body mass index [BMI] ≥35 with comorbid conditions or BMI ≥40) to women without a history of bariatric surgery according to age and breast cancer screening history. Nonsurgical controls were divided into 4 BMI categories (<25, 25-29, 30-34, and ≥35). Data were analyzed on October 21, 2021. Exposures Weight loss via bariatric surgery. Main Outcomes and Measures Residual hazard of breast cancer after washout periods of 1, 2, and 5 years. Comparisons were made between the surgical and nonsurgical cohorts overall and within each of the BMI subgroups. Results In total, 69 260 women were included in the analysis, with 13 852 women in each of the 5 study cohorts. The mean (SD) age was 45.1 (10.9) years. In the postsurgical cohort vs the overall nonsurgical cohort (n = 55 408), there was an increased hazard for incident breast cancer in the nonsurgical group after washout periods of 1 year (hazard ratio [HR], 1.40 [95% CI, 1.18-1.67]), 2 years (HR, 1.31 [95% CI, 1.12-1.53]), and 5 years (HR, 1.38 [95% CI, 1.21-1.58]). When the postsurgical cohort was compared with the nonsurgical cohort with BMI less than 25, the hazard of incident breast cancer was not significantly different regardless of the washout period, whereas there was a reduced hazard for incident breast cancer among postsurgical patients compared with nonsurgical patients in all high BMI categories (BMI ≥25). Conclusions and Relevance Findings suggest that bariatric surgery was associated with a reduced risk of developing breast cancer for women with prior obesity equivalent to that of a woman with a BMI less than 25 and a lower risk when compared with all groups with BMI greater than or equal to 25.
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Affiliation(s)
- Aristithes G. Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Lovrics
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J. Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence Paszat
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Jean-Eric Tarride
- ICES, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Elnahas AI, Reid JN, Lam M, Doumouras AG, Anvari M, Schlachta CM, Alkhamesi NA, Hawel JD, Urbach DR. Bariatric Center Designation and Outcomes Following Repeat Abdominal Surgery in Bariatric Patients. J Surg Res 2022; 280:421-428. [PMID: 36041342 DOI: 10.1016/j.jss.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Repeat abdominal surgery in the bariatric surgery patient population may be challenging for non-bariatric-accredited institutions. The impact of regionalized bariatric care on clinical outcomes for bariatric surgery patients requiring repeat abdominal surgery is currently unknown. This study aims to investigate the association between bariatric center designation and clinical outcomes following hepatobiliary, hernia, and upper and lower gastrointestinal operations among patients with prior bariatric surgery. METHODS This is a cohort study of a large sample of Ontario residents who underwent primary bariatric surgery between 2010 and 2017. A comprehensive list of eligible abdominal operations was captured using administrative data. The primary outcome was 30-d complications. Secondary outcomes included 30-d mortality, readmission, and length of stay. RESULTS Among the 3301 study patients, 1305 (40%) received their first abdominal reoperation following bariatric surgery at a designated bariatric center. Nonbariatric center designation was not associated with significantly higher rates of 30-d complications (5.73% versus 5.72%), mortality (0.80% versus 0.77%), readmissions (1.11% versus 1.85%), or median postoperative length of stay (4 versus 4 d). After grouping the category of reoperations, upper gastrointestinal (odds ratio [OR] 0.66, confidence interval [CI] 0.39-1.11) and abdominal wall hernia surgery (OR 0.52, CI 0.27-0.99) showed a lower adjusted OR for complications among bariatric centers. CONCLUSIONS Our study demonstrates that after adjustment for case-mix and patient characteristics, bariatric surgery patients undergoing repeat abdominal surgery at nonbariatric centers is not associated with higher proportion of complications or mortality. Complex hernia surgery may be considered the most appropriate for referral.
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Affiliation(s)
- Ahmad I Elnahas
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES, London, Ontario, Canada.
| | | | | | - Aristithes G Doumouras
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Anvari
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nawar A Alkhamesi
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jeffrey D Hawel
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David R Urbach
- ICES, London, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Doumouras AG, Lovrics O, Paterson JM, Sutradhar R, Paszat L, Sivapathasundaram B, Tarride JE, Anvari M. Bariatric Surgery and Breast Cancer Incidence: a Population-Based, Matched Cohort Study. Obes Surg 2022; 32:1261-1269. [PMID: 35212909 DOI: 10.1007/s11695-022-05946-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Obesity is associated with increased breast cancer risk in women. Bariatric surgery induces substantial weight loss. However, the effects of such weight loss on subsequent breast cancer risk in women with obesity are poorly understood. To examine breast cancer incidence and related outcomes in women with obesity undergoing bariatric surgery. MATERIALS AND METHODS This was a population-based matched cohort study of breast surgery outcomes utilizing linked clinical databases in Ontario, Canada. Women with obesity who underwent bariatric surgery were 1:1 matched using a propensity score to non-surgical controls for age and breast cancer screening history. The main outcomes were incidence of breast cancer after lag periods of 1, 2, and 5 years. Additional outcomes included tumor hormone receptor status, cancer stage, and treatments undertaken. Time-varying Cox proportional hazard models accounting for screening during follow-up were used to model cancer incidence. RESULTS A total of 12,724 women per group were included, average age 45.09. After a 1-year lag, breast cancer incidence occurred in 1.09% and 0.79% of the control and surgery groups, respectively (adjusted hazard ratio, 0.81 [95%CI 0.69-0.95]; p = 0.01). This association was maintained after lag periods of 2 and 5 years. Women in the surgical cohort diagnosed with breast cancer were more likely to have low-grade tumors and less likely to have high-grade tumors (overall p < 0.01). No association was found for tumor hormone receptor status, although the surgical group was more likely to have her2neu-negative tumors (p = 0.01). CONCLUSION Bariatric surgery was associated with a lower incidence of breast cancer and lower tumor grade in women with obesity. Further evaluation of outcomes, including mortality, is required.
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Affiliation(s)
- Aristithes G Doumouras
- Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada
- ICES, Toronto, ON, M4N 3M5, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Division of General Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Olivia Lovrics
- Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada
| | - J Michael Paterson
- ICES, Toronto, ON, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Lawrence Paszat
- ICES, Toronto, ON, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | | | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4L8, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada.
- ICES, Toronto, ON, M4N 3M5, Canada.
- Division of General Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Doumouras AG, Lee Y, Paterson JM, Gerstein HC, Shah BR, Sivapathasundaram B, Tarride JE, Anvari M, Hong D. Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity. JAMA Netw Open 2021; 4:e216820. [PMID: 33900401 PMCID: PMC8076963 DOI: 10.1001/jamanetworkopen.2021.6820] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE There are high-quality randomized clinical trial data demonstrating the effect of bariatric surgery on type 2 diabetes remission, but these studies are not powered to study mortality in this patient group. Large observational studies are warranted to study the association of bariatric surgery with mortality in patients with type 2 diabetes. OBJECTIVE To determine the association between bariatric surgery and all-cause mortality among patients with type 2 diabetes and severe obesity. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based matched cohort study included patients with type 2 diabetes and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 35 or greater who underwent bariatric surgery from January 2010 to December 2016 in Ontario, Canada. Multiple linked administrative databases were used to define confounders, including age, baseline BMI, sex, comorbidities, duration of diabetes diagnosis, health care utilization, socioeconomic status, smoking status, substance abuse, cancer screening, and psychiatric history. Potential controls were identified from a primary care electronic medical record database. Data were analyzed in 2020. EXPOSURE Bariatric surgery (gastric bypass and sleeve gastrectomy) and nonsurgical management of obesity provided by the primary care physician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality and nonfatal morbidities. Groups were compared through a multivariable Cox proportional Hazards model. RESULTS A total of 6910 patients (mean [SD] age at baseline, 52.04 [9.45] years; 4950 [71.6%] women) were included, with 3455 patients who underwent bariatric surgery and 3455 match controls and a median (interquartile range) follow-up time of 4.6 (3.22-6.35) years. In the surgery group, 83 patients (2.4%) died, compared with 178 individuals (5.2%) in the control group (hazard ratio [HR] 0.53 [95% CI, 0.41-0.69]; P < .001). Bariatric surgery was associated with a 68% lower cardiovascular mortality (HR, 0.32 [95% CI, 0.15-0.66]; P = .002) and a 34% lower rate of composite cardiac events (HR, 0.68 [95% CI, 0.55-0.85]; P < .001). Risk of nonfatal renal events was also 42% lower in the surgical group compared with the control group (HR, 0.58 [95% CI, 0.35-0.95], P = .03). Of the groups that had the highest absolute benefit associated with bariatric surgery, men had an absolute risk reduction (ARR) of 3.7% (95% CI, 1.7%-5.7%), individuals with more than 15 years of diabetes had an ARR of 4.3% (95% CI, 0.8%-7.8%), and individuals aged 55 years or older had an ARR of 4.7% (95% CI, 3.0%-6.4%). CONCLUSIONS AND RELEVANCE These findings suggest that bariatric surgery was associated with reduced all-cause mortality and diabetes-specific cardiac and renal outcomes in patients with type 2 diabetes and severe obesity.
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Affiliation(s)
| | - Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - J. Michael Paterson
- ICES, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Hertzel C. Gerstein
- Population Health Research Institute, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Baiju R. Shah
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | | | - Jean-Eric Tarride
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare, McMaster University, Hamilton, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Canada
- ICES, Toronto, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Canada
- ICES, Toronto, Canada
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Doumouras AG, Hong D, Lee Y, Tarride JE, Paterson JM, Anvari M. Association Between Bariatric Surgery and All-Cause Mortality: A Population-Based Matched Cohort Study in a Universal Health Care System. Ann Intern Med 2020; 173:694-703. [PMID: 32805135 DOI: 10.7326/m19-3925] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mortality after bariatric surgery has been previously studied, but cohort selection bias, completeness of follow-up, and collection of confounders have limited the inference of results. OBJECTIVE To determine the association between bariatric surgery and all-cause mortality. DESIGN Population-based matched cohort study. SETTING Ontario, Canada. PARTICIPANTS 13 679 patients who underwent bariatric surgery from January 2010 to December 2016 and 13 679 matched nonsurgical patients. INTERVENTION Bariatric surgery. MEASUREMENTS The primary outcome was all-cause mortality, with cause-specific mortality as the secondary outcome. Patients were matched according to age, sex, body mass index, and diabetes duration. RESULTS 13 679 patients who underwent bariatric surgery were matched to 13 679 nonsurgical patients. After a median follow-up of 4.9 years, the overall mortality rate was 1.4% (n = 197) in the surgery group and 2.5% (n = 340) in the nonsurgery group, with a lower adjusted hazard ratio (HR) of overall all-cause mortality (HR, 0.68 [95% CI, 0.57 to 0.81]). Patients aged 55 years or older had an absolute risk reduction of 3.3% (CI, 2.3% to 4.3%), with a lower HR of mortality in the surgery group (HR, 0.53 [CI, 0.41 to 0.69]). Observed relative effects were similar across sex; however, the observed association in absolute terms was greater in men. Surgery also was associated with lower cardiovascular mortality (HR, 0.53 [CI, 0.34 to 0.84]) and lower cancer mortality (HR, 0.54 [CI, 0.36 to 0.80]). LIMITATION The observational design limits causal inference. CONCLUSION Bariatric surgery was associated with substantially lower all-cause, cardiovascular, and cancer mortality. The lowered observed mortality of surgery was significant across most subgroups. The largest absolute effects were for men and patients aged 55 years or older. PRIMARY FUNDING SOURCE Ontario Bariatric Network.
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Affiliation(s)
- Aristithes G Doumouras
- Center for Health Economics and Policy Analysis, McMaster University and Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, and ICES, Toronto, Ontario, Canada (A.G.D.)
| | - Dennis Hong
- McMaster University and Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, and ICES, Toronto, Ontario, Canada (D.H., M.A.)
| | - Yung Lee
- McMaster University and Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada (Y.L.)
| | - Jean-Eric Tarride
- Programs for Assessment of Technology in Health, The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (J.T.)
| | - J Michael Paterson
- ICES and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, and McMaster University, Hamilton, Ontario, Canada (J.M.P.)
| | - Mehran Anvari
- McMaster University and Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, and ICES, Toronto, Ontario, Canada (D.H., M.A.)
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Springer JE, Doumouras AG, Eskicioglu C, Hong D. Regional Variation in the Utilization of Laparoscopy for the Treatment of Rectal Cancer: The Importance of Fellowship Training Sites. Ann Surg Oncol 2019; 27:2478-2486. [DOI: 10.1245/s10434-019-08115-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Indexed: 01/22/2023]
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Murphy R, Ghafel M, Beban G, Booth M, Bartholomew K, Sandiford P. Variation in public‐funded bariatric surgery intervention rate by New Zealand region. Intern Med J 2019; 49:391-395. [DOI: 10.1111/imj.14226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rinki Murphy
- Department of Medicine, Faculty of Medical and Health SciencesUniversity of Auckland Auckland New Zealand
- Auckland Diabetes CentreAuckland City Hospital, Auckland District Health Board Auckland New Zealand
- Whitiora Diabetes ServiceMiddlemore Hospital, Counties Manukau District Health Board Auckland New Zealand
| | - Mazin Ghafel
- Planning, Funding and Outcomes UnitAuckland and Waitemata District Health Boards Auckland New Zealand
- Health Systems DepartmentSchool of Population Health, University of Auckland Auckland New Zealand
| | - Grant Beban
- Department of SurgeryAuckland City Hospital, Auckland District Health Board Auckland New Zealand
| | - Michael Booth
- Department of SurgeryNorth Shore Hospital, Waitemata District Health Board Auckland New Zealand
| | - Karen Bartholomew
- Planning, Funding and Outcomes UnitAuckland and Waitemata District Health Boards Auckland New Zealand
| | - Peter Sandiford
- Planning, Funding and Outcomes UnitAuckland and Waitemata District Health Boards Auckland New Zealand
- Health Systems DepartmentSchool of Population Health, University of Auckland Auckland New Zealand
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Doumouras AG, Saleh F, Hong D. The effect of distance on short-term outcomes in a regionalized, publicly funded bariatric surgery model. Surg Endosc 2018; 33:1167-1173. [PMID: 30116951 DOI: 10.1007/s00464-018-6383-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission. METHODS This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission. Multivariable logistic regression was used to examine the impact of distance from patients' primary residence to their bariatric COE on patient outcomes and readmissions. RESULTS Five thousand and seven patients were identified, two-thirds residing within 100 km of a COE with a mean distance of 117.2 km. The majority of patients did not reside within a Local Integrated Health Network (LHIN) that contained a COE, while 18.3% of patients lived in rural areas. Using multivariable adjustment, for every 10 km increase from the COE where surgery was performed, the Odds Ratio (OR) for complications was 1.00 [95% Confidence Interval (CI) 0.99-1.01; P = 0.747]. Additionally, both residing in a LHIN without a COE, OR 1.10 (95% CI 0.87-1.40; P = 0.434), and rural status, OR 0.97 (95% CI 0.77-1.23; P = 0.821) showed no increase in risk of complication. Similarly, further distances did not influence rate of readmission, OR 0.99 (95% CI 0.98-1.00; P = 0.077) nor did rural status OR 1.31 (95% CI 0.97-1.76; P = 0.076). CONCLUSION The COE model, where a few centers in high population areas service a large geographic region, is adequate in ensuring patients that live further away receive appropriate short-term care.
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Affiliation(s)
- Aristithes G Doumouras
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Fady Saleh
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Anvari M, Lemus R, Breau R. A Landscape of Bariatric Surgery in Canada: For the Treatment of Obesity, Type 2 Diabetes and Other Comorbidities in Adults. Can J Diabetes 2017; 42:560-567. [PMID: 29724616 DOI: 10.1016/j.jcjd.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023]
Abstract
Obesity has escalated worldwide and in Canada. Many chronic conditions, including type 2 diabetes, are directly correlated with obesity, and although the benefits and effectiveness of bariatric surgery have been proven in terms of sustained weight loss and improving comorbidities, the procedure is underaccessed and underutilized in Canada. We explored the complex landscape of bariatric surgery in Canada, reviewing the current state and focusing on the volume of procedures nationwide and at the provincial level, the type of surgical procedures performed, their outcomes and their associated complications. Barriers and challenges curbing access to bariatric surgery are also explored. Approximately 8,583 publicly funded bariatric surgeries were performed in 9 of 10 provinces in 2015/2016; Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric banding and biliopancreatic diversion with or without duodenal switch are the most common procedures performed, and coverage varies among provinces and territories. Dedicated bariatric programs have been created and, in some instances, provincial networks have also emerged. Weight loss, resolution of comorbidities and rates of complications in Canada are similar to those found in the literature. The increase in the number of bariatric procedures performed over time has still not met the current demand. The rise in obesity rates, the speed and regional variations in the development and standardization of processes, adequate patient selection, funding and prioritization and gaps in knowledge and attitudes about the merits of bariatric surgery of patients, health providers and policy makers create considerable waiting times and are some of the barriers to better access to bariatric surgery.
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Affiliation(s)
| | | | - Ruth Breau
- McMaster University, Hamilton, Ontario, Canada
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Twells LK, Driscoll S, Gregory DM, Lester K, Fardy JM, Pace D. Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada. BMC OBESITY 2017; 4:40. [PMID: 29238600 PMCID: PMC5725939 DOI: 10.1186/s40608-017-0176-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
Background In Canada, severe obesity (BMI ≥ 35 kg/m2) affects 5% or 1.2 million adults. Bariatric surgery is the only effective treatment for severe obesity, but the demand for publicly funded procedures is high and capacity limited. Little is known in Canada about the types of patients undergoing these procedures, especially laparoscopic sleeve gastrectomy (LSG). The study objective is to examine the socio-demographic profile, morbidity and HRQoL of patients accessing LSG in one Canadian province. Methods Health status and HRQoL were examined in patients (n = 195) undergoing LSG. HRQoL was assessed using the EQ-5D-3L, SF-12v2 and the Impact of Weight on Quality of Life-lite questionnaire. Results Mean age and BMI were 44 and 49 kg/m2 and most were women (82%). Pre-surgery, comorbidities were sleep apnea (65%), dyslipidemia (48%), hypertension (47%) and osteoarthritis (44%). Patients reported impaired HRQoL with 44-67% reporting problems in mobility, usual activities, pain and anxiety/depression. Physical health was impaired more than mental health. There were few socio-demographic differences between women and men, but significant differences in comorbid conditions such as sleep apnea, dyslipidemia, hypertension and gout exist (p < .05). Women reported fewer problems with self-care (9.5% vs. 25.0%, p < .05), and better overall health (VAS 61.5 vs. 52.0, p < .05) and General Health (39.3 vs. 32.9, p < .05), but greater impairment in self-esteem (27.3 vs. 44.1, p < .01) and sexual life (49.2 vs. 63.6, p < .05). Conclusions Before LSG, patients reported significant morbidity and impaired HRQoL. Although baseline characteristics were similar between men and women, gender specific differences were observed in comorbid profile and HRQoL.
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Affiliation(s)
- Laurie K Twells
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive Newfoundland and Labrador, St. John's, A1B 3V6 Canada
| | - Shannon Driscoll
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Kendra Lester
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - John M Fardy
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Dave Pace
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
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Hennings DL, O’Malley TJ, Baimas-George M, Al-Qurayshi Z, Kandil E, DuCoin C. Buckle of the bariatric surgery belt: an analysis of regional disparities in bariatric surgery. Surg Obes Relat Dis 2017; 13:1290-1295. [DOI: 10.1016/j.soard.2017.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/06/2017] [Accepted: 03/24/2017] [Indexed: 01/08/2023]
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Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy. Surgery 2017; 162:203-210. [PMID: 28504112 DOI: 10.1016/j.surg.2017.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND A minimum-volume policy restricting hospitals not meeting the threshold from performing complex operation may increase travel burden and decrease spatial access to operation. We aim to identify vulnerable populations that would be sensitive to an added travel burden. METHODS We performed a retrospective analysis of the database of the California Office of Statewide Health Planning and Development for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed was used as a metric for travel. Patients bypassing fewer hospitals were deemed to be more sensitive to an added travel burden. RESULTS There were 13,374 patients who underwent a pancreatectomy, of whom 2,368 (17.7%) were nonbypassers. On unadjusted analysis, patients >80 year old travelled less than their younger counterparts, bypassing a mean of 10.9 ± 9.5 hospitals compared with 14.2 ± 21.3 hospitals bypassed by the 35-49 year old age group (P < .001). Racial minorities travelled less when compared with non-Hispanic whites (P < .001). Patients identifying their payer status as self-pay (8.9 ± 15.6 hospitals bypassed) and Medicaid (10.1 ± 17.2 hospitals bypassed) also travelled less when compared with patients with private insurance (13.8 ± 20.4 hospitals bypassed, P < .001). On multivariate analysis, advanced age, racial minority, and patients with self-pay or Medicaid payer status were associated independently with increased sensitivity to an added travel burden. CONCLUSION In patients undergoing pancreatectomy, the elderly, racial minorities, and patients with self-pay or Medicaid payer status were associated with an increased sensitivity to an added travel burden. This vulnerable cohort may be affected disproportionately by a minimum-volume policy.
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Doumouras AG, Saleh F, Anvari S, Gmora S, Anvari M, Hong D. The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada. Surg Endosc 2017; 31:4816-4823. [DOI: 10.1007/s00464-017-5559-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/01/2017] [Indexed: 12/20/2022]
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Doumouras AG, Saleh F, Sharma AM, Anvari S, Gmora S, Anvari M, Hong D. Geographic and socioeconomic factors affecting delivery of bariatric surgery across high- and low-utilization healthcare systems. Br J Surg 2017; 104:891-897. [DOI: 10.1002/bjs.10517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 01/02/2023]
Abstract
Abstract
Background
In countries with universal health coverage, the delivery of care should be driven by need. However, other factors, such as proximity to local facilities or neighbourhood socioeconomic status, may be more important. The objective of this study was to evaluate which geographic and socioeconomic factors affect the delivery of bariatric care in Canada.
Methods
This was a national retrospective cohort study of all adult patients undergoing bariatric surgery between April 2008 and March 2015 in Canada (excluding Quebec). The main outcome was neighbourhood rate of bariatric surgery per 1000 obese individuals (BMI over 30 kg/m2). Geographic cluster analysis and multilevel ordinal logistic regression were used to identify high-use clusters, and to evaluate the effect of geographic and socioeconomic factors on care delivery.
Results
Having a bariatric facility within the same public health unit as the neighbourhood was associated with a 6·6 times higher odds of being in a bariatric high-use cluster (odds ratio (OR) 6·60, 95 per cent c.i. 1·90 to 22·88; P = 0·003). This finding was consistent across provinces after adjusting for utilization rates. Neighbourhoods with higher obesity rates were also more likely to be within high-use clusters (OR per 5 per cent increase: 2·95, 1·54 to 5·66; P = 0·001), whereas neighbourhoods closer to bariatric centres were less likely to be (OR per 50 km: 0·91, 0·82 to 1·00; P = 0·048).
Conclusion
In this study, across provincial healthcare systems with high and low utilization, the delivery of care was driven by the presence of local facilities and neighbourhood obesity rates. Increasing distance to bariatric centres substantially influenced care delivery.
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Affiliation(s)
- A G Doumouras
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - F Saleh
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - A M Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - S Anvari
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - S Gmora
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - M Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - D Hong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
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le Roux C, Aroda V, Hemmingsson J, Cancino AP, Christensen R, Pi-Sunyer X. Comparison of Efficacy and Safety of Liraglutide 3.0 mg in Individuals with BMI above and below 35 kg/m²: A Post-hoc Analysis. Obes Facts 2017; 10:531-544. [PMID: 29145215 PMCID: PMC5836203 DOI: 10.1159/000478099] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate whether the efficacy and safety of liraglutide 3.0 mg differed between two subgroups, BMI 27 to <35 and BMI ≥ 35 kg/m², in individuals without and with type 2 diabetes (T2D). METHODS A post-hoc analysis of two 56-week, randomized, double-blind, placebo-controlled trials (SCALE Obesity and Prediabetes; SCALE Diabetes). Subgroup differences in treatment effects of liraglutide 3.0 mg were evaluated by testing the interaction between treatment group and baseline BMI subgroup. RESULTS Significantly greater weight loss (0-56 weeks) was observed with liraglutide 3.0 mg versus placebo in all patient groups while on treatment. There was no evidence that the weight-lowering effect of liraglutide 3.0 mg differed between BMI subgroups (interaction p > 0.05). Similarly, for most secondary endpoints significantly greater improvements were observed with liraglutide 3.0 mg versus placebo, with no indication treatment effects differing between subgroups. The safety profile of liraglutide 3.0 mg was broadly similar across BMI subgroups. CONCLUSION This post-hoc analysis did not indicate any differences in the treatment effects, or safety profile, of liraglutide 3.0 mg for individuals with BMI 27 to <35 or ≥35 kg/m². Liraglutide 3.0 mg can therefore be considered for individuals with a BMI of ≥35 as well as for those with a BMI of 27 to <35 kg/m².
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Affiliation(s)
- Carel le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- *Prof. Dr. Carel Le Roux, Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland,
| | - Vanita Aroda
- MedStar Health Research Institute, Hyattsville, MD, USA
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Saleh F, Doumouras AG, Gmora S, Anvari M, Hong D. Outcomes the Ontario Bariatric Network: a cohort study. CMAJ Open 2016; 4:E383-E389. [PMID: 27730102 PMCID: PMC5047839 DOI: 10.9778/cmajo.20150112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bariatric surgery centres of excellence are relatively new in Canada and were first started in Ontario in 2009. This study presents short-term outcomes of Canada's largest bariatric collaborative, from Ontario, during its first 3 years. METHODS We performed a population-based cohort study that included all patients (age ≥ 18) who received a Roux-en-Y gastric bypass or sleeve gastrectomy for the purpose of weight loss from March 2009 to April 2012 within Ontario. Data were derived from the Canadian Institute for Health Information Discharge Abstract and Hospital Morbidity Databases. Primary outcomes included short-term overall complication rate, reoperation rate, anastomotic leak rate and death. Hierarchical logistic regression was used to identify risk factors for overall complications. A median odds ratio (OR) was used to compare risk-adjusted complication rates across centres of excellence. RESULTS A total of 5007 procedures (91.7% Roux-en-Y gastric bypass, 8.3% sleeve gastrectomy) were performed during the 3-year study period, with an overall complication rate of 11.7% (95% confidence interval [CI] 10.8%-12.6%). The leak rate was 0.84% (95% CI 0.61%-1.13%), the reoperation rate was 4.6% (95% CI 4.0%-5.2%) and mortality was 0.16% (95% CI 0.07%-0.31%). Male sex, chronic kidney disease and osteoarthritis were identified as risk factors for overall complications (p value < 0.05). The median ORs across centres of excellence, calculated for both overall complications and reoperation rate, were 1.76 and 1.49, respectively. INTERPRETATION Bariatric surgery within Ontario has similar short-term outcomes to those of other major world centres. The variability of outcomes within centres of excellence highlights areas for program quality improvement.
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Affiliation(s)
- Fady Saleh
- Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont
| | - Aristithes G Doumouras
- Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont
| | - Scott Gmora
- Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont
| | - Mehran Anvari
- Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont
| | - Dennis Hong
- Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont
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Doumouras AG, Saleh F, Hong D. 30-Day readmission after bariatric surgery in a publicly funded regionalized center of excellence system. Surg Endosc 2015; 30:2066-72. [PMID: 26275546 DOI: 10.1007/s00464-015-4455-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/12/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Avoidable readmission after surgery is a major burden on healthcare resources and is common after major surgery. Bariatric surgery is one of the most common surgical procedures in North America, and there is a paucity of strategies to prevent readmission. Strategies for prevention must first identify actual risk factors before interventions can be designed. METHODS Our objective was to evaluate the readmission rate, characteristics of readmitted patients, and factors associated with readmission. We performed a population-based cohort study that included all patients who received a Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) procedure in Ontario from April 2009 until March 2012 for the purposes of weight loss. Data were derived from the Canadian Institute for Health Information Discharge Abstract Database and Hospital Morbidity Database. RESULTS Over 3 years, 5007 procedures (91.7 % RYGB, 8.1 % SG) were performed with an overall 30-day readmission rate of 6.1 %. Readmission stays of 72 h or less accounted for 83 % of the cohort. The most common reasons for readmission were: infectious complications (24.6 %), pain (16.4 %) nausea/vomiting (11.5 %), bleeding complications (11.5 %), obstruction (5.6 %). A complication during initial admission OR 2.07 (95 % CI 1.44-2.97; P value < 0.001) and a length of stay greater than 2 days OR 1.40 (95 % CI 1.07-1.84; P value = 0.013) were independent predictors of readmission within 30 days. CONCLUSION The readmission rate after bariatric surgery in Ontario is similar to other major population-based bariatric surgery programs. Complications on initial admission and prolonged length of stay were independent predictors of readmission. Considering a large proportion of the readmissions were short term, future research into potential measures to prevent these readmissions is essential.
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Affiliation(s)
- Aristithes G Doumouras
- Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Fady Saleh
- Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
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