The impact of a standardized program on short and long-term outcomes in bariatric surgery

The purpose of this study was to determine whether there has been an improvement in short- and long-term clinical outcomes since 2010, when the Ontario Bariatric Network led a province-wide initiative to establish a standardized system of care for bariatric patients. The system includes nine bariatric centers, a centralized referral system, and a research registry. Standardization of procedures has progressed yearly, including guidelines for preoperative assessment and perioperative care. Analysis of the OBN registry data was performed by fiscal year between April 2010 and March 2015. Three-month overall postoperative complication rates and 30 day postoperative mortality were calculated. The mean percentage of weight loss at 1, 2, and 3 years postoperative, and regression of obesity-related diseases were calculated. The analysis of continuous and nominal data was performed using ANOVA, Chi-square, and McNemar's testing. A multiple logistic regression analysis was performed for factors affecting postoperative complication rate. Eight thousand and forty-three patients were included in the bariatric registry between April 2010 and March 2015. Thirty-day mortality was rare (< 0.075 %) and showed no significant difference between years. Three-month overall postoperative complication rates significantly decreased with standardization (p < 0.001), as did intra-operative complication rates (p < -0.001). Regression analysis demonstrated increasing standardization to be a predictor of 3 month complication rate OR of 0.59 (95 %CI 0.41-0.85, p = 0.00385). The mean percentage of weight loss at 1, 2, and 3 years postoperative showed stability at 33.2 % (9.0 SD), 34.1 % (10.1 SD), and 32.7 % (10.1 SD), respectively. Sustained regression in obesity-related comorbidities was demonstrated at 1, 2, and 3 years postoperative. Evidence indicates the implementation of a standardized system of bariatric care has contributed to improvements in complication rates and supported prolonged weight loss and regression of obesity-related diseases in patients undergoing bariatric surgery in Ontario.