title: Current challenges in providing bariatric surgery in France: A nationwide study.
abstract: Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or depression. Universal health insurance coverage for low-income patients was inversely correlated with the probability of RYGB.Differences in access to surgery have been observed in terms of the patient's profile, geographical variations, and predictors of types of procedures. Several challenges must be met when organizing the medical care of this growing number of patients, when delivering surgery through qualified centers while assuring the quality of long-term follow-up for all patients.
authors.affiliation: Assistance-Publique Hôpitaux de Paris, Department of Nutrition, Georges-Pompidou european Hospital, Centre Spécialisé Obésité IdF Sud, Paris Inserm UMS 011, Population-Based Cohort Group, Villejuif Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris Department of Surgery, CHU Montpellier, Faculty of Medicine of Montpellier, Montpellier Service de Chirurgie Digestive, Centre Intégré de l'Obésité CINFO, CHU Louis Mourier (AP-HP), Colombes Université Paris Diderot, PRES Sorbonne Paris Cité Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital France Sorbonne Universities, University Pierre et Marie Curie, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.forename: Michel
authors.initials: M
authors.lastname: Paita
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.forename: Arnaud
authors.initials: A
authors.lastname: Basdevant
authors.forename: Bertrand
authors.initials: B
authors.lastname: Millat
authors.forename: Anne
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005602:France; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012959:Socioeconomic Factors