Background:
Access to public hospital bariatric surgery is limited. There is comparatively little data available on outcomes of surgery in the public sector. Such data is crucial in advocating for greater public surgery.
Aim:
To examine outcomes of a tertiary public bariatric surgery service.
Methods:
A 6 year audit of a prospective database years 2010-2016 of surgical outcomes at the Austin Hospital, Victoria.
Results:
The cohort consisted of 530 patients, 70% female, mean age 51 and BMI 49.
90% of patients had at least one significant co morbidity and 20% had 3 or more metabolic complications of their obesity. Diabetes was present in 39%.
609 procedures were performed in the audit period. Of these 45% of these were revisional and of these 86% were band related. External legacy patients comprised 20% of the revisional work load.
Over the audit period there was a significant shift in procedure from gastric banding to resectional procedures (GB 73% 2010, 5% 2016).
Major (Accordion>=3) complication rate was 1.5% for primary and 13% for revisional procedures.
Overall, 12% of patients have no record of follow up and 42% had not attended clinic within the last 12 months at the point of audit. Mean available follow up was 24 months (3-88 months).
Weight loss outcomes were comparable to most reported series. Overall %EWL at 2 years for primary surgery was 56% (Band 40%, Sleeve 52%, Bypass 75%).
Comorbidity resolved or improved in 80% of diabetes, 63% hypertension and 60% sleep apnoea.
Conclusion:
Bariatric surgery in the public setting can be delivered safely and with efficacy. Patients are heavier, and more comorbid than in the private sector and revisional surgery burden is significant, particularly with gastric banding. Follow up is a major challenge and creative systems need to be developed in the setting of limited resources.