title: Outcomes of high-volume bariatric surgery in the public system.
abstract: BACKGROUND
  Bariatric surgery has not been widely used in the Australian public health system. As obesity is strongly associated with socio-economic status, excluding its use from the public system will deny many of the most in-need access to a potentially very effective treatment. Alternatively, with rigorous follow-up and behavioural change requirements, highly successful outcomes in the private system may not translate to the public system.
  
  
  METHODS
  The Alfred Hospital rapidly expanded bariatric surgery from 2007. A 6-year prospective follow-up study was conducted with annual review of weight, co-morbidities, retention in follow-up, serum HbA1c, quality of life and patient satisfaction.
  
  
  RESULTS
  There were 1453 patients. Procedures were predominantly laparoscopic-adjustable gastric bands (n = 861). Patient details were age 49 ± 11 years, body mass index 50.7 ± 11.2 kg/m(2) and weight 139.0 ± 30.2 kg. There was no mortality, and mean length of stay was 1.1 ± 1.2 days. Follow-up was 98% (1 year) and 85% (6 years). Weight loss was 22 ± 13.1 kg (32.8 ± 18% excess weight loss) at 1 and 30.1 ± 16.8 kg (60 ± 28%) at 6 years. The mean number of co-morbidities was 4.2 ± 1.1 with significant improvements observed. Patient satisfaction was 7.7 ± 2.3 out of 10. Mental and physical summary scores (SF-36) improved from 41.02 ± 13.17 to 45.50 ± 13.27 (P < 0.001) and 33.97 ± 10.53 to 44.79 ± 11.19 (P < 0.001).
  
  
  CONCLUSIONS
  Patients were older, heavier and suffered more co-morbid disease than previously reported cohorts. For the first time, excellent outcomes across a range of key quality domains in a large patient cohort have been reported in the public system. High-volume bariatric surgery in the public system is viable.
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Burton
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Brown
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Chen
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Kalai
authors.initials: K
authors.lastname: Shaw
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Packiyanathan
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Ingra
authors.initials: I
authors.lastname: Bringmann
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nottle
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011634:Public Health; D011788:Quality of Life; D013997:Time Factors; D015431:Weight Loss / Q000502:physiology*
keywords: bariatric; laparoscopic gastric band; outcome; public