ANZ Journal of SurgeryEarly View LETTER TO THE EDITOR Invited author's response to Letter to the Editor 'Complexities of bariatric surgery funding and registry capture limits LOS conclusion applicability' Chiara Chadwick MBBS, FRACS, Chiara Chadwick MBBS, FRACS orcid.org/0000-0002-5866-6919 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorPaul R. Burton PhD, FRACS, Paul R. Burton PhD, FRACS Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorJennifer Reilly FANZCA, PhD, Jennifer Reilly FANZCA, PhD orcid.org/0000-0002-7109-8493 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorDianne Brown BEc(Hons), Dianne Brown BEc(Hons) Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorJennifer F. Holland BSpPath, MHlthInfoMgmt, Jennifer F. Holland BSpPath, MHlthInfoMgmt Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorAngus Campbell BSc, Angus Campbell BSc Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorJenifer Cottrell ADC Cert., DDS, Jenifer Cottrell ADC Cert., DDS Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorAndrew D. MacCormick PhD, FRACS, Andrew D. MacCormick PhD, FRACS Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, Australia Department of Surgery, University of Auckland, Auckland, New ZealandSearch for more papers by this authorIan Caterson PhD, FRACP, Ian Caterson PhD, FRACP Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorWendy A. Brown PhD, FRACS, Wendy A. Brown PhD, FRACS orcid.org/0000-0002-0137-2688 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, Australia Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this author Chiara Chadwick MBBS, FRACS, Chiara Chadwick MBBS, FRACS orcid.org/0000-0002-5866-6919 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorPaul R. Burton PhD, FRACS, Paul R. Burton PhD, FRACS Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorJennifer Reilly FANZCA, PhD, Jennifer Reilly FANZCA, PhD orcid.org/0000-0002-7109-8493 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorDianne Brown BEc(Hons), Dianne Brown BEc(Hons) Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorJennifer F. Holland BSpPath, MHlthInfoMgmt, Jennifer F. Holland BSpPath, MHlthInfoMgmt Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorAngus Campbell BSc, Angus Campbell BSc Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorJenifer Cottrell ADC Cert., DDS, Jenifer Cottrell ADC Cert., DDS Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this authorAndrew D. MacCormick PhD, FRACS, Andrew D. MacCormick PhD, FRACS Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, Australia Department of Surgery, University of Auckland, Auckland, New ZealandSearch for more papers by this authorIan Caterson PhD, FRACP, Ian Caterson PhD, FRACP Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorWendy A. Brown PhD, FRACS, Wendy A. Brown PhD, FRACS orcid.org/0000-0002-0137-2688 Monash University Department of Surgery, Central Clinical School, Alfred Health, Melbourne, Victoria, Australia Oesophago-Gastric and Bariatric Unit, Alfred Health, Melbourne, Victoria, Australia Monash University, School of Public Health and Preventive Medicine, Bariatric Surgery Registry, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 22 April 2024 https://doi.org/10.1111/ans.19005 Dr. Wendy Brown is an Editorial Board member of ANZ Journal of Surgery and a co-author of this article. To minimize bias, they were excluded from all editorial decision-making related to the acceptance of this article for publication. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Ettorchi-Tardy A, Levif M, Michel P. Benchmarking: a method for continuous quality improvement in health. Healthc Policy. 2012; 7: e101–e119. PubMedGoogle Scholar 2Chadwick C, Burton PR, Brown D et al. Bariatric surgery efficiency, safety and health outcomes in government versus privately funded hospitals. Obes. Surg. 2023; 33: 1160–1169. 10.1007/s11695-023-06489-3 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

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 (CI 95% 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 (CI 95% 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. Graphical Abstract

BACKGROUND:The length of a patient's stay (LOS) in a hospital is one metric used to compare the quality of care, as a longer LOS may flag higher complication rates or less efficient processes. A meaningful comparison of LOS can only occur if the expected average length of stay (ALOS) is defined first. This study aimed to define the expected ALOS of primary and conversion bariatric surgery in Australia and to quantify the effect of patient, procedure, system, and surgeon factors on ALOS. METHODS:This was a retrospective observational study of prospectively maintained data from the Bariatric Surgery Registry of 63 604 bariatric procedures performed in Australia. The primary outcome measure was the expected ALOS for primary and conversion bariatric procedures. The secondary outcome measures quantified the change in ALOS for bariatric surgery resulting from patient, procedure, hospital, and surgeon factors. RESULTS:Uncomplicated primary bariatric surgery had an ALOS (SD) of 2.30 (1.31) days, whereas conversion procedures had an ALOS (SD) of 2.71 (2.75) days yielding a mean difference (SEM) in ALOS of 0.41 (0.05) days, P < 0.001. The occurrence of any defined adverse event extended the ALOS of primary and conversion procedures by 1.14 days (CI 95% 1.04-1.25), P < 0.001 and 2.33 days (CI 95% 1.54-3.11), P < 0.001, respectively. Older age, diabetes, rural home address, surgeon operating volume and hospital case volume increased the ALOS following bariatric surgery. CONCLUSIONS:Our findings have defined Australia's expected ALOS following bariatric surgery. Increased patient age, diabetes, rural living, procedural complications and surgeon and hospital case volume exerted a small but significant increase in ALOS. STUDY TYPE:Retrospective observational study of prospectively collected data.

Purpose Bariatric surgery is an efficacious intervention for substantial and sustained weight reduction in individuals with morbid obesity resulting in health improvements. However, the changes to a patient’s health related quality of life (HRQoL) in the medium to longer term after bariatric surgery have not been adequately characterized. Our aim was to evaluate the change to patient HRQoL 5 years following bariatric surgery in an Australian government-funded hospital system and determine the significance of relationships between change in physical and mental assessment scores and HRQoL utility scores. Materials and Methods We performed a longitudinal panel study of 81 adult patients who underwent primary bariatric surgery at an Australian tertiary government-funded hospital and completed multi-attribute utility (MAU), multi-attribute non-utility (MA), and disease-specific adjusted quality of life (AQoL) questionnaires before and after bariatric surgery. Results At a mean (SD) 5.72 (1.07) years postbariatric surgery, participants demonstrated statistically significant improvements in mean AQoL-8D utility (0.135 (0.21); P < 0.0001), yielding a mean 3.2 (1.67) QALYs gained. Beck Depression Inventory-II scores improved (baseline mean 17.35 (9.57); 5-year mean 14.7 (11.57); P = 0.037). Short Form-36 scores improved in the domains of physical functioning and role limitations due to physical health and general health. Change in depression scores and patient satisfaction with surgery were found to be significant predictors of follow up AQoL utility scores. Conclusions Bariatric surgery improves physical and psychological quality of life measures over 5 years. The improvement of patient QALYs provide insight to the potential cost utility of publicly funded bariatric surgery in the medium term. Graphical abstract

BACKGROUND:To determine whether a bariatric surgical procedure is associated with a reduction in healthcare utilisation among patients with obesity and high pre-procedural healthcare needs.METHODS:Design: Retrospective cohort study.SETTING:Tertiary Victorian public hospital.PARTICIPANTS:Twenty-nine adults who underwent publicly funded primary bariatric surgery between 2008 and 2018 at the Alfred Hospital, Melbourne and had high resource use over the year prior to surgery, defined as at least two of ≥3 hospital admissions, ≥7 inpatient bed days for obesity-related co-morbidities or inpatient hospital costs ≥$10 000.MAIN OUTCOME MEASURES:Change in inpatient and outpatient resource use.RESULTS:After 1 year following bariatric surgery, total hospital bed days decreased from 663 to 80 and the median (Q1, Q3) per patient decreased from 7 (4.5, 15) to 5 (2.25, 9.75) (p = 0.001) and the total number of hospital admissions fell from 118 to 67 (p < 0.001). The median cost of inpatient care decreased from $11 405 ($4408, $22251) to $3974 ($0, $4325) per annum (p < 0.001). The total and median number of outpatient attendances did not significantly change 12 months after bariatric surgery, but the demand for outpatient services unrelated to bariatric surgery declined by a median of four visits per patient (p = 0.013).CONCLUSIONS:The evidence from this small pilot study suggests that Bariatric surgery has the potential to decrease resource use and inpatient hospital costs over a 1-year time frame for obese patients with high resource use. These data will be used to design a prospective randomised controlled trial to provide more definitive information on this important issue.