Public hospital bariatric surgery benefits make a compelling case for wider access

Risk factors

By Rosanne Barrett

1 Jun 2022

Bariatric surgeries for obesity have equally good outcomes in both public and private hospitals, leading clinicians to call for greater uptake of the procedure in the state-run system.

A study of 995 Australians who had bariatric surgeries performed at the Austin Hospital, Melbourne, showed that there was sustained weight loss and significant improvement or resolution of conditions such as hypertension and diabetes.

From a baseline mean BMI of 49.6 kg/m2 the overall, percentage total body weight loss for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At two years follow-up, treatment was ceased or reduced in 29% of hypertensive patients, 65% of people with diabetes and 69% of sleep apnoea patients.

And although public patients tended to be older, heavier and have more co-morbidities than private patients, they did not require a high level of resourcing. The usual length of hospital stay primary surgery patients did not exceed two nights. Similarly, the primary surgery major complication rates were comparable to those of the national Bariatric Surgery Registry (2.4% vs 2.1%) as were the revisional rates (7.3% vs 9.3%).

“It is often feared that bariatric surgical patients require a disproportionate volume of inpatient resources. We have found this not to be the case,” the study authors said.

They noted that only about 6% of bariatric surgeries for obesity are done in the public system. And while 22 public hospitals reported performing bariatric surgeries in 2019, only 10 provide a significant volume (>75 cases/year).

“The paucity of services nationally means that many patients currently are unable to access care yet could benefit greatly. It is imperative that provision of public bariatric surgery services be increased urgently and appropriate resourcing for follow-up care be supported,” the authors wrote in ANZ Journal of Surgery.

Support services lacking

Co-author Dr Ahmad Aly said very few public hospitals had a bariatric surgery program but it was a government responsibility to address this. “Largely this is due to the ongoing misconception that obesity is a consequence of lifestyle choice rather than understanding that obesity is a chronic disease of genetic disposition,” he told the limbic.

He said the lack of support for multidisciplinary teams “outside the operating theatre” in the public system – dietitians, psychologists, specialist nurses, exercise physiologists and bariatric medicine specialists – meant public hospitals were less likely to offer the service.

“This means treatment for obesity is viewed as lesser priority, despite the fact that obesity is in fact the single greatest contributor to ill health burden in our community. If we were to address obesity seriously and devote resources appropriately to its treatment, including surgery, we could have a substantial impact on health, save lives and ultimately reduce costs.”

He said the procedures should be offered more broadly, given they remained the most effective therapy for obesity and related diseases, such as diabetes.

“Bariatric surgery is often referred to as metabolic surgery because it has profound impacts on metabolic disease including diabetes, hypertension, sleep apnoea, hyperlipidemia, fatty liver and inflammatory conditions. It treats polycystic ovarian disease and infertility. In addition, it has a significant impact on arthritic conditions, reducing the need for and protecting the longevity of joint replacements. Most strikingly it reduces cardiovascular death and cancer related death.”

“Currently less than 2% of patients that could benefit access surgery,” he said. “It needs to be made more widely available and part of everyday hospital care.”

The study reviewed outcomes for 674 primary surgeries and 412 revisional procedures for patients who had bariatric surgery at the Austin Hospital in Victoria from 2010 to 2020.

At two years, people who had bariatric surgery lost 26.2% on average. People who had gastric bands lost an average of 19.4% of their total body weight, while those who had a sleeve gastrectomy lost 29.5%.  Those with a gastric bypass lost 38.8%.

Likewise, at five years the weight loss remained about the same for gastric banding and gastric bypass, but reduced to 20.9% for sleeve gastrectomy. Overall, people had lost 21.1% of their total body weight.

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