title: Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records.
abstract: This study aimed to use primary care electronic health records to evaluate the epidemiology of bariatric surgery in the UK.
  
  
  
  A cohort comprising all obese patients with a bariatric surgical procedure was drawn from the Clinical Practice Research Datalink (CPRD). Rates of bariatric surgery were estimated using the registered CPRD population as denominator.
  
  
  
  There were 3039 adult obese patients with first bariatric surgery procedures between 2002 and 2014, including laparoscopic adjustable gastric banding (LAGB), 1297; gastric bypass (GBP), 1265; and sleeve gastrectomy (SG), 477. Annual procedures increased from one in 2002 to a maximum of 525 in 2010. Intervention rates were greatest among those aged 35-54, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. The mean age and body mass index of participants increased, as did the proportion of men and proportion with diabetes. Between 2002 and 2006, LAGB accounted for >90 % of procedures; in 2014, GBP accounted for 52 % and SG 26 %. Among patients initially receiving LAGB, the rate of band removal was 1.6 (95 % confidence interval 1.3-2.0) per 100 patient years; the rate of a second procedure of a different type was 1.2 (0.9-1.5) per 100 patient years.
  
  
  
  Numbers of bariatric surgical procedures have increased with increasing use of GBP and SG. Rates of bariatric surgery per 100,000 population remain low and provide evidence of limited access to bariatric surgical procedures in relation to need.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD, UK. helen.booth@kcl.ac.uk.|Department of Surgery, St George's Hospital, Blackshaw Rd, London, SW17 0QT, UK. helen.booth@kcl.ac.uk.
authors.forename: Helen P
authors.initials: HP
authors.lastname: Booth
authors.affiliation: Department of Surgery, St George's Hospital, Blackshaw Rd, London, SW17 0QT, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Khan
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Fildes
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: A Toby
authors.initials: AT
authors.lastname: Prevost
authors.affiliation: Department of Surgery, St George's Hospital, Blackshaw Rd, London, SW17 0QT, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, 6th Floor, Capital House, 42 Weston St, London, SE1 3QD, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Bariatric surgery; Body weight; Diabetes mellitus; Gastric banding; Gastric bypass; Obesity; Primary care; Sleeve gastrectomy