Bariatric Surgery: Provision and Outcomes in New Zealand

Abstract

Aim: To gain a holistic and current understanding of health burden of obesity and the surgical management of obesity in New Zealand. With a specific focus on understanding the provision, outcomes and patient experience of bariatric surgery at Te Whatu Ora – Te Tai Tokerau, formerly Northland District Health Board (NDHB), Te Whatu Ora – Waitematā, formerly Waitematā District Health Board (WDHB) and across New Zealand (NZ). Methods: A literature review was performed to understand the international and national literature on obesity and bariatric surgery. A five year retrospective study was performed of patients who received bariatric surgery at NDHB and WDHB. A qualitative study was performed to understand the barriers patients encountered in receiving bariatric surgery at NDHB. The protocol for a national multicentre retrospective observational cohort study (PROVINZ Study) was designed to mirror the retrospective study conducted as part of this thesis. Findings: The epidemiology of obesity and metabolic syndrome, the pattern of disease, predictors of adverse outcomes from obesity, scoring systems used to understand obesity as well risks of bariatric surgery, morbidity and mortality outcomes, medical and surgical treatment options and current clinical guidelines for management of obesity are summarised in the literature review. There is significant inequity in the provision of bariatric surgery, such that eligible patients who resides in Northland are six times less likely to receive bariatric surgery than patients with the same disease residing in Waitematā. Eligible patients in Northland primarily fail to receive bariatric surgery because of the weight loss expectation as part of the pre-operative requirements for eligibility. The other themes identified showed that the overall design of the bariatric surgical service fails to support patients psychologically, physically, socially and economically. Conclusion: Bariatric surgery offers life changing results for patients who suffer from obesity. The distribution of bariatric surgery between different geographical areas is not equitable and should be distributed on a needs based approach. If we want to deliver patient centred care in bariatric surgery then significant work is needed to improve how patients interact with bariatric services.