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Morbidity and Morality Rates After Bariatric Surgery in a Regionalized Surgical Care Program: the Ontario Experience
Aristithes Doumouras*2, Fady Saleh3, Mehran Anvari1, Dennis Hong1
1Surgery, St Joseph, Hamilton, ON, Canada; 2McMaster University, Hamilton, ON, Canada; 3University of Toronto, Toronto, ON, Canada
Introduction:
As part of the diabetes and obesity prevention strategy in Ontario, the Ministry of Health formed the Ontario Bariatric Network (OBN) in 2009. The OBN introduced the first Bariatric Centres of Excellence program for bariatric surgery in Canada, consisting of 7 hospitals within 4 centers. Since its inception, there has been no systematic, population-based outcomes reported. Our objective was to evaluate the mortality and major morbidity of bariatric surgery in Ontario during the initial years of the implementation of a regionalized surgical care program.
Methods:
Provincial population-based cohort study that included all patients aged >18 years who received a Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) or laparoscopic adjustable gastric band (LAGB) procedure in the province of Ontario from March 2008 until 2011.for the purposes of weight loss who met National Institute of Health criteria for weight loss surgery. Data was derived from the Canadian Institute for Health Information Discharge Abstract Database and Hospital Morbidity Database. Our patient population was defined using descriptive statistics and compared across procedures using the Pearson's Chi2 test for categorical data and the Kruskal-Wallis test for continuous data. Complication and mortality rates and their confidence intervals were defined by the exact binomial distribution and univariate comparisons of complications and mortality rates between the three bariatric procedures were performed using the Fisher's exact test. .
Results:
Over the program's initial 4 years, 5,618 procedures (90.5% RYGB, 7.5% SG and 2.0% LAGB) were performed. Mean age was 44.4 +10.3. 81.8% were female. 28.4% of our patient had type 2 diabetes. The overall serious complication rate was 5.3% (95% CI: 4.7 - 5.9). Complications were most common after RYGB (5.5%; 95% CI: 4.9 - 6.1) followed by SG (4.3%; 95% CI: 2.6 - 6.7) and LAGB (0.9%; 95% CI: 0.02 - 4.9) procedures (p<0.05). Re-operative rate was 0.71% on initial admission. The mortality rate for all procedures was 0.12% (95% CI: 0.05-0.26), greatest in patients who underwent SG at 0.24% (95% CI: 0.01-1.31), followed by RYGB at 0.12 (95% CI: 0.04-0.26), and LAGB at 0%, but these differences were not statistically significant (p=0.503).
Conclusions:
Major morbidity and mortality in patients undergoing bariatric surgery since the inception of the Ontario Bariatric Network centre of excellence model is relatively low. The rates are comparable to other major population-based reports on bariatric surgery.
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