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. 2016 Sep 14;4(3):E489-E495.
doi: 10.9778/cmajo.20160042. eCollection 2016 Jul-Sep.

The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

Ahmad Elnahas  1 , Timothy D Jackson  1 , Allan Okrainec  1 , Peter C Austin  1 , Chaim M Bell  1 , David R Urbach  1
Affiliations

The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

Ahmad Elnahas et al. CMAJ Open. .

Abstract

Background: In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network.

Methods: We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery.

Results: A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively).

Interpretation: The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study design and follow-up for cohorts.
See this image and copyright information in PMC

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