Metabolic Surgery Statistics — 2008

On November 29, 2009, in Uncategorized, by Andrea

This morning, I came across this article by Buchwald and Oien (thanks Bonamy) outlining worldwide WLS statistics for 2008.  According to the authors, the last evaluation was done in 2003 and this evaluation was done by sending a survey to 39 nations or national groupings (of which 36 responded).  Given this was a survey, it will be somewhat biased based on the person answering the survey, as well as the fact that the numbers are worldwide — some procedures are done in other parts of the world that are not performed in the US routinely (such as Vertical Banded Gastroplasty {VBG}) or the Scopinaro Biliopancreatic procedure.  Of course, I am a numbers girl and wish that all numbers are exact figures, but let’s face it — it’s not realitySo given that, I have to concede that these are not going to be 100% exact.

Some direct quotes and figures from the report:

  • In 2008, 344, 221 bariatric surgery operations were performed by 4,680 bariatric surgeons, 220,000 of these operations were performed in USA/Canada by 1,625 surgeons
  • Seven other countries or national groupings with more than 100 bariatric surgeons: Australia/New Zealand (118), Brazil (700), Chile (100), France (310), Italy (300), Mexico (150), and Spain (400)
  • 91.4% of world bariatric surgery was performed laparoscopically
  • Considering all gastric bypasses together (distal and prox, open and lap), number of RNY exceeds AGB’s.
  • In Europe, relative percent of AGB decreased from 63.7% to 43.2% from 2003 to 2008, while RYGB increased from 11.1% to 39%.  In USA, AGB increased from 9% to 44% and RYGB decreased from 85% to 51%.  In both Europe and USA, VSG went from 0% in 2003 to 4%.
  • Most common type of procedures were purely restrictive (AGB, VSG, VBG) (48.6%), restrictive/malabsorptive (RNY) (49.0%), and primarily malabsorptive (BPD/DS) (2%).

Surgical types by breakdown (Lap and Open combined)

  1. Proximal RNY – 45.4%
  2. AGB – 42.4%
  3. VSG – 5.4%
  4. VBG – 1.1%
  5. BPD and DS procedures combined – 1.1%
  6. Other – 0.1%

The authors make a few conclusions about the numbers they received in this survey — some of which bother me.  There is quite a disenchantment of AGB in Europe, where there is quite a long history of it’s use there, and a growing trend towards VSG and RYGB there.  USA and Canada, where we want newer and better (and have marketing via TV commercials?  WTF?) is moving away RYGB (which we have a longer history) and are moving towards AGB and VSG.  In no cases are we moving closer to DS — which in many ways to ME seems to be an excellent choice and not given any credit or opportunity to shine.  The authors also clearly bring up the fact that many people would presumably want metabolic surgery if they could get their paws on it — would even, I dunnow, self-pay for it, or change jobs for it, or go work part-time at the Buxx for it?  For those of us in the community, we’ve seen and heard this time and time again so nice to see the professionals recognize it in a published article.  Additionally — patients are getting smarter, using the interwebz and understanding a bit more about what we are doing to our guts when we go and get chopped up — and it’s all for the betterment:

Further involved factors may be the predictable craving for something regionally newer, the imposition of payer mandates, media-derived prejudices and and biases, advertisement campaigns by the bariatric surgery industry, increased patient sophistication and use of websites, and, of course, relative regional economic advantages for bariatric surgeons.

I have to say the thing I’m most concerned about is the complete lack of yeast in the DS numbers.  This is a wonderful surgery — doesn’t have many of the RNY pitfalls (and let me tell you, I know several of them first hand), doesn’t require all that much more work than far-out RNY patients (despite what some may tell you — it’s not all roses and rainbows and unicorns) and just isn’t getting the recognition or the opportunity to shine and show it’s stuff.  I wish more surgeons would learn how to perform it.  I wish more people would learn the stats.  I wish more people would stop spreading misinformation crap about it in hopes of making their own surgery look better.  And I wish many of the surgeons that don’t perform it would also stop this practice — it’s unprofessional as all hell and only perpetuates the problems as their patients then do the exact same thing and continues to spread the misinformation, fear, and, eventually, hatred, around.

Europe at least is performing the DS a bit more than we are -0-  they had a 58.7% increase of surgeries from 03 to 08 — but still that increase only comprised 4.9% of the total surgery population in 08 which is an actual decrease from 6.1% surgical population in 03.  Comparatively, the US went from 4.5% surgical population in 03 to 1%?!? in 08?  with a 52.5% decrease.  WHY? I don’t get it.  There is too much good in the DS for this statistic.  At least the US wasn’t as abysmal as Asia and the Pacific.. those numbers were too depressing to even type out.

So what does all of this mean?  WLS is on the rise, but not as much as it was in 03.  Considering how quickly the rate of obesity is climbing, this isn’t quite proportionate as some critics claim (including many private payers who don’t want to cover WLS as it would “cost too much”) — and given how diabetes costs are going to triple by 2023? This is a way to go to help avoid these ballooning costs.  Some surgeries are growing by leaps and bounds regionally — some are growing regardless (VSG, anyone?)  and some are still performed in areas while considered completely antiquated in others (VBG in the US).

Very interesting.  Somewhat sad.  But very interesting.