|
1
|
Chadwick C, Burton PR, Brown D, Holland JF, Campbell A, Cottrell J, MacCormick AD, Caterson I, Brown WA. Bariatric Surgery Efficiency, Safety and Health Outcomes in Government Versus Privately Funded Hospitals. Obes Surg 2023; 33:1160-1169. [PMID: 36795288 PMCID: PMC10079711 DOI: 10.1007/s11695-023-06489-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE This study aims to determine if the hospital efficiency, safety and health outcomes are equal in patients who receive bariatric surgery in government-funded hospitals (GFH) versus privately funded hospitals (PFH). MATERIALS AND METHODS This is a retrospective observational study of prospectively maintained data from the Australia and New Zealand Bariatric Surgery Registry of 14,862 procedures (2134 GFH and 12,728 PFH) from 33 hospitals (8 GFH and 25 PFH) performed in Victoria, Australia, between January 1st, 2015, and December 31st, 2020. Outcome measures included the difference in efficacy (weight loss, diabetes remission), safety (defined adverse event and complications) and efficiency (hospital length of stay) between the two health systems. RESULTS GFH treated a higher risk patient group who were older by a mean (SD) 2.4 years (0.27), P < 0.001; had a mean 9.0 kg (0.6) greater weight at time of surgery, P < 0.001; and a higher prevalence of diabetes at day of surgery OR = 2.57 (CI95%2.29-2.89), P < 0.001. Despite these baseline differences, both GFH and PFH yielded near identical remission of diabetes which was stable up to 4 years post-operatively (57%). There was no statistically significant difference in defined adverse events between the GFH and PFH (OR = 1.24 (CI95% 0.93-1.67), P = 0.14). Both healthcare settings demonstrated that similar covariates affect length of stay (LOS) (diabetes, conversion bariatric procedures and defined adverse event); however, these covariates had a greater effect on LOS in GFH compared to PFH. CONCLUSIONS Bariatric surgery performed in GFH and PFH yields comparable health outcomes (metabolic and weight loss) and safety. There was a small but statistically significant increased LOS following bariatric surgery in GFH.
Collapse
Affiliation(s)
- Chiara Chadwick
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia. .,Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, 3004, Australia.
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.,Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, 3004, Australia
| | - Dianne Brown
- School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia
| | - Jennifer F Holland
- School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia
| | - Angus Campbell
- School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia
| | - Jenifer Cottrell
- School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia
| | - Andrew D MacCormick
- School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia.,Department of Surgery, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Ian Caterson
- Boden Initiative, Charles Perkins Centre, University of Sydney, New South Wales, 2006, Sydney, Australia.,Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, 2050, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.,Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Monash University, Melbourne, 3004, Australia
| |
Collapse
|