Private and Public Bariatric Surgery Trends in New Zealand 2004-2017: Demographics, Cardiovascular Comorbidity and Procedure Selection.

BACKGROUND

For bariatric surgery, patient selection, procedural choice and availability has changed over time internationally. We analysed the annual volume and location of bariatric surgery in New Zealand by demographic characteristics, clinical history and procedure.

METHODS

Patients who underwent bariatric procedures between 1 January 2004 and 31 December 2017 were identified through New Zealand hospitalisation records. Hospitalisation and medication data were used to indicate a clinical history of cardiovascular disease (CVD) and/or diabetes. Publicly funded intervention rate by ethnicity was calculated using year- and sex-specific ethnic population estimates and obesity prevalence statistics.

RESULTS

This study included 9109 patients, undergoing gastric bypass (GB, n = 3323) and sleeve gastrectomy (SG, n = 5452) as the most common procedures. Nationally, annual bariatric surgery volume increased in the public sector, from 34 to 516 between 2004 and 2017, with a similar increase in available private sector figures. Public recipients were significantly more likely to have a history of diabetes (33.8% vs 14.4%) and/or CVD (9.0% vs 4.7%) than private recipients. Male recipients had higher prevalence of diabetes (29.9% vs 17.6%) and CVD (12.9% vs 4.1%) than female recipients. After adjustment for the adult population prevalence of morbid obesity, Pacific people had half the intervention rate of European and Māori.

CONCLUSION

Bariatric surgery is increasing in frequency in New Zealand, with SG and GB being the most common procedures. Significant differences in patient characteristics exist between the public and private sectors. Ensuring equitable selection of publicly funded bariatric surgery candidates remains a challenge.