A. Elnahas1, T. Jackson1, A. Okrainec1, P. Austin2, C. Bell3, D. Urbach1,2 1University of Toronto,General Surgery,Toronto, Ontario, Canada 2Institute For Clinical Evaluative Sciences,Toronto, Ontario, Canada 3University of Toronto,General Internal Medicine,Toronto, Ontario, Canada
Introduction: In 2009, the Ontario Ministry of Health and Long-term Care created the Ontario Bariatric Network (OBN)—a network of four interdisciplinary regional Bariatric Centers of Excellence—in an effort to address the exploding demand for bariatric surgery services funded outside Canada. The impact of outsourcing bariatric surgery to other jurisdictions, which can lack appropriate follow-up and supervision of patients, remains unexplored. The objective of this study is to compare postoperative hospital services use among Ontario residents who received bariatric surgery before and after implementation of the OBN.
Methods: We conducted a retrospective, uncontrolled, before-and-after study using administrative data held at the Institute for Clinical Evaluate Sciences. All Ontario residents who underwent funded first-time bariatric surgery were included in the study. Use of hospital services within one year following surgery was compared between the 3-year periods before (2007-2009) and after (2010-2012) establishment of the OBN. Secondary outcomes included physician visits, re-operations and mortality.
Results: A total of 5,617 and 6,896 patients received bariatric surgery before and after implementation of the OBN, respectively. The two cohorts shared similar baseline characteristics. After adjustment for age, sex, neigborhood income quintile, rurality, procedure type and Adjusted Clinical Group comorbidity score, implementation of the OBN was associated with less days requiring postoperative hospital services (rate ratio [RR] 0.83, 95% CI 0.78 to 0.89, P<0.001), including less time in intensive care (RR 0.53, 95% CI 0.35 to 0.81, P=0.003) and a lower 1-year mortality (odds ratio [OR] 0.44, 95% CI 0.23 to 0.82, P=0.01). No statistically significant differences were found with respect to re-hospitalization or re-operation rates. Not surprisingly, the physician visit rate was significantly higher after the OBN (RR 3.50, 95% CI 3.19 to 3.84, P<0.001).
Conclusion: In our study of health services use among a large number of patients who received bariatric surgery before and after introduction of a comprehensive organized program, we found that a multidisciplinary bariatric program provided a safer model of care compared to outsourcing bariatric surgical services.