Bariatric Surgery: A Weighty Issue
The use of bariatric surgery has increased 20-fold in Western Australia over the past 17 years, according to a research paper in the latest issue of Medical Journal of Australia. Researchers believe this is indicative of a national trend of obese Australians turning to bariatric surgery as a long-term treatment option.
Fiona Smith, a PhD candidate at the University of Western Australia's School of Population Health, and her co-authors investigated the incidence of this procedure and its postoperative outcomes in a retrospective, population-based study in Western Australian hospitals between 1988 and 2004.
Ms Smith said that in an increasingly obesogenic environment, demand for bariatric procedures was continuing. In the study, the incidence increased from 1.2 procedures per 100,000 person-years in 1988 to 24.2 procedures per 100,000 person years in 2004.
"Although some of this was ascribed to a rising prevalence of obesity generally, there was a 13-fold increase in the bariatric procedure rate within the obese population itself," Ms Smith said.
Adopted in the 1990s, laparoscopic adjustable gastric banding (LAGB) is the bariatric procedure of choice in more than 90 per cent of Australian cases. It involves reducing the amount of food that the stomach can hold, thus causing a feeling of fullness. Gastric bypass is used in most of other cases.
More than 1,400 patient outcomes were studied. Females accounted for nearly 85 per cent of all hospital separations with nine procedures performed on Indigenous Australians.
The mean age of patients increased steadily over the study period from 36.9 years to 42.3 years. The length of hospital stay ranged from one day to 136 days - the median length of stay was two days in 2000-2004.
Ms Smith said the results showed that five years after surgery, the relative survival rate in bariatric patients was the same as the survival rate in the general population.
"Within the 30-day postoperative period, mortality was low (0.7 per cent) and less than 10 per cent of patients experienced complications. Patients who underwent the less common gastric bypass procedure were more likely to be re-admitted within 30 days of their operation," she said.
The study results indicated that bariatric surgery was a safe procedure, with excellent prospects for survival. However, the researchers issued a warning to those who thought the procedure was without danger.
"Candidates for bariatric surgery should continue to be carefully selected and counselled on the potential and inherent risks posed by this type of surgery," Ms Smith said.
"The most important intervention against obesity is the work of public health professionals in primary prevention. Clinicians also have a role to play in prevention as well as the treatment of patients who are morbidly obese. They are responsible for ensuring that clinical research is translated into evidence-based practice guidelines. Policymakers have a responsibility to support prevention and to facilitate equitable access to safe weight-loss procedures for those who need them," she said.