Regional Variation In Bariatric Surgery In Ontario

In 2009, Ontario began offering bariatric surgery in the public system across the province. This was primarily offered in 4 Centres of Excellence (COE):  Toronto, Ottawa, Hamilton and Guelph.

Now, an analysis of how this distribution of centres affected rates of surgery in various geographic parts of Ontario has been published in the Annals of surgery.

The authors mapped all adult patients who received bariatric surgery from April 2009 to March 2012 to their geographic neighbourhoods to determine those with significantly higher (hot spots) or lower (cold spots) rates of surgery.

As one may expect, rates of surgery declined in proportion to distance from the centre – rates decreased by about 10% per 100 km distance from the nearest COE.

In contrast, odds of for having surgery in a COE within the same administrative health region as the neighbourhood were about 75% higher than for people living outside the health region.

Interestingly however, the analysis also identified 40 cold spot neighbourhoods, within a relatively small geographic area that happens to contains 3 of the 4 COEs.

Why this would be is anyones guess, but may well have to do with issues related to patient or provider attitudes to surgery for obesity than availability of the service.

Since 2012, two more COEs have been established in Ontario (complemented by several non-surgical “assessment centres”). How much of an impact this has had on access will remain to be seen.

In the meantime, it should be acknowledged that access to bariatric surgery in Ontario has substantially increased since the establishment of the COEs (surgery rates are currently only higher in Quebec).

How the province deal with non-surgical obesity management, a task that will largely fall to primary care, remains to be seen.

@DrSharma
Edmonton, AB