Starting a successful bariatric surgical practice in the community hospital setting.
BACKGROUND
3% of the population is morbidly obese and experience many associated medical problems. Surgical procedures have been shown to achieve sustained weight loss not attainable by other measures, lessening the co-morbidities. However, most general surgeons have been reluctant to expand their practice to include bariatric surgery. The current study demonstrates the benefits of including bariatric surgery in a general surgeon's practice in a community hospital.


METHODS
Hospital charts of patients undergoing a gastric bypass procedure between 1997 and 2000 were reviewed. Demographic data, co-morbid conditions, intra-operative times, and post-operative weight loss were recorded. Follow-up data was obtained using a mailed survey based on the BAROS survey.


RESULTS
168 patients underwent a Roux-en-Y gastric bypass procedure. Follow-up was obtained for 86 patients. Average pre-operative weight was 141 kg (BMI = 50). There was an average loss of 55% of excess weight by the second post-operative year. Operative times decreased as the number of the procedures performed by the surgeon increased. Over half of the patients surveyed reported improvements for each of the co-morbid conditions that were assessed (i.e., diabetes, back pain, etc.). Five categories of quality of life were assessed, and over 66% of patients reported improvements in all areas. In 44% of the patients, payment was obtained from private insurance and 56% from Medicare or Medicaid. There were no deaths.


CONCLUSIONS
Adding bariatric surgery to a general surgeon's practice in the community setting can be beneficial to patients, intellectually stimulating and emotionally rewarding for the surgeon, and economically feasible for the institution.
Schoepel
K L
KL
New Hanover Regional Medical Center, Coastal Area Health Education Center, Wilmington, NC, USA. schoepel@med.unc.edu
Olchowski
S E
SE
Mathis
M W
MW
Pridgen
P D
PD
Maxwell
J G
JG
D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006764:Hospitals, Community; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D011364:Professional Practice / Q000639:trends*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012649:Self Concept; D012725:Sexual Behavior; D015431:Weight Loss