Bariatric Surgery: Prevalence And Treatment - American Society For .
Bariatric Surgery:Prevalence and TreatmentSamer G. Mattar, MD, FACS, FASMBS,ABOMMedical DirectorSwedish Weight Loss ServicesPresident, American Society for Metabolicand Bariatric Surgery
Disclosures Gore:Honorarium2
ASMBS The largest national society for this specialty. Founded 1983 Nearly 4,000 members including general surgeonsand integrated healthcare professionals practicing inthe field of metabolic and bariatric surgery.3
The vision of the Societyis to improve public healthand wellbeing bylessening the burden ofthe disease of metabolicdysfunction and obesitythroughout the world.4
The purpose of thesociety is to advance theart and science ofmetabolic and bariatricsurgery by continuallyimproving the qualityand safety of care andtreatment of people withobesity and relateddisease.5
Prevalence¶ of Self-Reported Obesity Among U.S. Adultsby State and Territory, BRFSS, 2016Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not becompared to prevalence estimates before 2011.¶*Sample size 50 or the relative standard error (dividing the standard error by the prevalence) 30%.
Prevalence¶ of Self-Reported Obesity Among U.S.Adults by State and Territory, BRFSS, 2016Summaryq No state had a prevalence of obesity less than 20%.q 3 states and the District of Columbia had a prevalence ofobesity between 20% and 25%.q 22 states and Guam had a prevalence of obesity between25% and 30%.q 20 states, Puerto Rico, and Virgin Islands had a prevalenceof obesity between 30% and 35%.q 5 states (Alabama, Arkansas, Louisiana, Mississippi, andWest Virginia) had a prevalence of obesity of 35% or greater.¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalenceestimates before ps.html
US Population Clock The United States population on September 5th, 2018was: 328,515,980 Severe obesity rate in US 6% Calculated number of severely obese people in US 19,710,958 Obesity rate in US 36% Calculated number of obese people in US 118,265,752https://www.census.gov/popclock/9
Effect of Treatment on ObesityLifestyle Intervention 3%Medications 1%Surgery 1%Unmet 95%
Current volume of .60%0.57%0.70%Revision 20%Balloons ic-surgery-numbers11
Metabolic and Bariatric SurgeryProcedure Trends: 2011 - 2017
Metabolic and Bariatric SurgeryProcedure Trends: 2011 - 2017SleeveRYGB% change 2017from 20168.05%0.64%% change 2017from 201528.41% -10.39% -43.45% 35.03% 20.94% -10.62% 797.14% 15.92%% change 2017from 2011381%BandBPD/DS Revision-13.57% 28.48%7.18%Other BalloonsTotal-1.04%5.72%-30.03% -88.70% 11.67% 240.06% 10.88%9.33%44.31%
Economic and Legislative Impact byStates: There are 2 No1247CA4Yes3048HI23Yes4149MA9Yes550CO1Yes24 Top and Bottom 5 rankingstates States highest in obesityprevalence have loweconomic ranking and lowpenetrance and 4 of the 5states did not have BS asEHB. The opposite is true forlowest obesity rankingstates.14
2017 Numbers by StateRanked by VolumeState Total Sites Total YGBRevision/Conversion Band Removal 61279610143271061417552871516BPDDSBalloon ORYGB 26601704603423607030191112732121166
2017 Numbers by StateRanked by Volume Part HISDPRMTVTWYAKLRYGBPDDTotal15Sites TotalCases 2013LSGRevision/ConversionBand 129Removal LAGBBalloonORYGBOtherBS26911963081544311925191139 675347962236641671024991192 83720585161673174823761302 5453101821117117522711543 439152642999026920441553 11407545146000000000000000016
Top Ten States 2017StateTotal SitesTotal A419748OH297356MI316964NC236512MA316268
Future Volume of Bariatric Surgery Additional 6-8% per yearStill only 1-2% of eligible patientsContinued growth in Sleeve Gastrectomy casesContinued improvement in quality outcomesContinued growth in endoscopic modalitiesContinued growth in revision casesContinued shift to ambulatory casesPotential fragmentation of care of bariatric patients18
Review of MBSAQIP CurrentState& Associated Milestones
MBSAQIP Journey - 2012The MBSAQIP Journey 2012April 2012The Metabolic andBariatric SurgeryAccreditation and QualityImprovement Program isborn on April 1stHappy Birthday,MBSAQIP!March 2012Memorandum ofUnderstanding betweenACS and ASMBS tounify bariatric surgeryaccreditation programsAugust 2012All centers transition toMBSAQIP Data RegistryJune 2012Announced at ASMBSannual meeting as part ofMBSAQIPFall 2012Development ofStandards beginsDecember 2012Initiated First PublicComment Review ofMBSAQIP Standards(1100 responses!)
MBSAQIP Journey2013The MBSAQIP Journey 2013January 2013Work begins onApplication Portal(Development onSurveyor/ReviewerPortals begin)November 2013Designated Novemberas MBSAQIP SurveyorRecruitment (86recruited, on-boarded 67)Spring-Summer 2013Re-Write of StandardsbeginsApril 2013Development of MBSAQIPapplication, site visit, andreviewer process mapsand workflows commencein conjunction with AVPImeetingsAugust 2013Completed SecondPublic Comment Reviewof MBSAQIP Standards(1200 responses!)
MBSAQIPJourneyThe MBSAQIP Journey 20142014May 2014Launched and completedonline Surveyor training( HIPAA) in one monthMarch 2014Soft-launchedApplication Portal to 6Pilot SitesJanuary 2014Released Resources forthe Optimal Care of theMetabolic and BariatricSurgery PatientSeptember 2014Conducted our first sitevisit in Marquette, MIAugust 2014Went live with newMBSAQIP website onfacs.org domainJune 2014Opened ApplicationPortal to Initial* andRenewing CentersAugust 2014Launched MBSAQIPSurveyor Portal*171 NEW centers have applied to participatein MBSAQIP since June, 2014November 2014Host first ASKMBSAQIPDecember 2014Launched MBSAQIPReviewer andAdjudicator PortalNovember 2014Announced MBSAQIPData Registry as ACSʼsDecember 2014first Qualified ClinicalInvited 140 centers toData Registry (QCDR) at participate in DecreasingObesity Week in Boston, Readmissions throughMAOpportunities Provided(D.R.O.P.)
MBSAQIP Journey 2015The MBSAQIP Journey 2015February 2015February 27thDr. Max Hammercompletes our 100THSITE VISIT at IntegrisBaptist Medical Center inOklahoma City, OKJanuary 2015January 21stSt. Josephʼs in Syracuse,NY becomes the firstMBSAQIP center toreceive an official finalreport & accreditationunder the new program.June 2015June 26thFirst in-person course forMBSCRs at ObesityWeekendSeptember 20151st Anniversary ofMBSAQIP Site Visits335 site visitsconducted in first yearNovember 2015First Obesity WeekCourse where accreditedcenters were featuredand presented on howthey meet MBSAQIPStandards.
MBSAQIP Journey 2016The MBSAQIP Journey 2015Jan 2016MBSAQIP continuesdesignation as a QCDRfor participation in PQRSFeb/Mar 2016Publishing Version 2 ofMBSAQIP StandardsJun/Jul 2016New standards takeeffect – stay tuned forsurveyor training on newstandardsSummer 2016Wrap up DROP Projectand publish resultsFall 2016MBSAQIP launches 2ndNational Collaborativeproject – ENERGY
What’sComingin2017The MBSAQIP Journey 2015Jan 2017 First Participant Use DataFile (PUF) released SAR data 7/1/15 thru6/30/16Spring 2017Option for InternationalCenters to participate inData Collection OnlyMarch 2017Feb 2017Bariatric Abstracts due Surgeon consent due2/20/17 for ACS Q&S 3/1/17 to MBSAQIP toparticipate in QCDR – toConferenceavoid CMS penalties. Exhibiting @ SAGES3/22-3/25July 2017Official Kick-off for 2017National Quality Project:ENERGY2018MBSAQIP plans toOct/Nov 2017ACS Clinical Congressmigrate to a single dataregistry platform with&other ACS QualityObesity WeekPrograms (Cancer,Trauma, NSQIP, Peds,Surgeon Specific Reg, etal)July 2017 Introducing a Bariatric Trackaimed at MBSAQIP participants(MBS Directors, Coordinators,and MBSCRs) at the annualACS Quality & SafetyConference (formerly NSQIPConference) in New York, NY SAR data 1/1/2016 thru 12/31/16
MBSAQIP Staff StructureDROPCAdministrative DirectorSameera AliCQI Product OpsSenior ManagerMBSAQIP ProgramAdministratorTeresa FrakerProject ManagerKim Evans-LabokProgramAssistantLeticia JonesAdministrativeAssistantCheryl RoyAccreditation ServicesManagerAmy Robinson-GeraceMBSAQIP DataRegistry ManagerRasa KrapikasVerificationSpecialistPaul JeffersSr. ProgramCoordinatorTanya KimberProgram CoordinatorsSarah StuartKaynaat Syed(1 FTE OPEN)CQI StatisticsManagerMark CohenMBSAQIP cianArielle GriecoCQI IT ManagerPaul WillarsonDataManagers/Developers7 FTEs SharedCQI Clinical SupportServices Manager(open position)ClinicalSupportSpecialistsLisa HaleJesus DiazClaudia Byrd
MBSAQIP Surgeon CommitteeStructureACS Committee on Metabolic &Bariatric Surgery (CMBS)Chair: John Morton, MD, FACSStandards & Verification SubcommitteeData & Quality SubcommitteeCo-chair: David Provost, MD, FACSCo-chair: Wayne English, MD, FACSCo-chair: Stacy Brethauer, MD, FACSCo-chair: Anthony Petrick, MD, FACS
CURRENT ENROLLMENT There 828 participating MBSAQIP centers, of which 751are fully accredited and 47 are initial applicants The remaining 30 are Data Collection Centers that includeinternational centers or other domestic centers thatparticipate in the MBSAQIP Data Registry, but have not beenverified against MBSAQIP Standards for Accreditation. From October 2014 through April 2017, 796 site visitshave been completed under the MBSAQIP standards. In 2016, the program performed 291 site visits with 67surgeon surveyors.
Opioid “Epidemic”Center for Disease Control and Prevention, March 201729
30
THE GOALS OF ENHANCEDRECOVERY PATHWAYEvidence-based multidisciplinary care pathwayaimed at: Reducing complications and LOS Reducing variability Reducing cost Improving quality of care Decrease opioid exposure and use Increasing value
Summary Bariatric surgery volume will increase by 6-8% annual basisNeediest states will continue to have least penetrationEconomy, politics and raised awareness will play larger roles.Safety and quality outcomes will be valuable assetsAccreditation is the jewel in our crown.Expecting an expansion of indications for metabolic surgeryEmerging technology will play larger role (market)Focus on LTFU, VTE minimization and Opioid use limitation32
Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2016 Summary q No state had a prevalence of obesity less than 20%. q 3 states and the District of Columbia had a prevalence of obesity between 20% and 25%. q 22 states and Guam had a prevalence of obesity between 25% and 30%. q 20 states, Puerto Rico, and Virgin Islands had a prevalence
rates after bariatric surgery have fallen by 80% in the past decade. Data involving nearly 60,000 bariatric pa-tients from American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Centers of Excellence data-base show that the risk of death within the 30 days fol-lowing bariatric surgery av-erages 0.13%, or approxi-
1. Bariatric Clear Liquids: starts the day after surgery. 2. Bariatric Full Liquids: starts the day you go home from the hospital. 3. Bariatric Pureed Food: starts at your 2-week post-op clinic visit. 4. Bariatric Soft Foods: lasts about 2 weeks for Bypass and 4 weeks for the Sleeve. 5. Bariatric Regular diet: Begins at your 2-month post-op .
Post-bariatric surgery health behaviour changes. Post-bariatric surgery diet. Centres that perform bariatric surgery will typically provide pa-tients with a dietary protocol to follow. Initially, over several weeks, patients transition from liquid, to soft and then to a sol-id diet. Over the long term, patients are encouraged to follow
Bariatric Surgery Patient Binder Weight Loss Surgery Bariatric surgery, or weight loss surgery, is a tool to help people lose weight. When accompanied by permanent lifestyle changes, it can help individuals achieve lasting health benefits. Baptist Health Bariatric Center offers the lat-est and safest weight loss surgery options:
Improvement in mortality after bariatric surgery 72 1.21 Resolution of co - morbidities after bariatric surgery 73 1.22 Bariatric surgery leads to an improv ement in glucose homeostasis 74 1.23 The economic costs of obesity can be counteracted by obesity surgery 75 1.24 Our hypoth
This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. Coverage Policy . Coverage for bariatric surgery or revision of a bariatric surgery procedure varies across plans and may be governed by state mandates. Refer to t
Bellevue Bariatric Program February 2019 Lactose Intolerance and Sensitivity after Bariatric Surgery by Kat Cozza , PA-C Patients who have had bariatric surgery may experience a varie-ty of gastrointestinal changes. In particular, some bariatric by- pass patients may experience GI symptoms due to an intoler-ance or sensitivity to lactose found .
The Roundtable API procedure is deployed as source and is located in /rtb/p/rtb_api.p. Complete details on using the API can be found in the definitions section of the API procedure. 3.2 Example – Creating a Task 3.2.1 Initializing the API In its most basic form, initializing the API is just a matter running the API procedure
