Starting a successful bariatric surgical practice in the community hospital setting

Background: 3% of the population is morbidly obese and experience many associated medical problems. Surgical procedures have been shown to achieve sustained weight loss not attainable by other measures, lessening the co-morbidities. However, most general surgeons have been reluctant to expand their practice to include bariatric surgery. The current study demonstrates the benefits of including bariatric surgery in a general surgeon's practice in a community hospital. Methods: Hospital charts of patients undergoing a gastric bypass procedure between 1997 and 2000 were reviewed. Demographic data, co-morbid conditions, intra-operative times, and post-operative weight loss were recorded. Follow-up data was obtained using a mailed survey based on the BAROS survey. Results: 168 patients underwent a Roux-en-Y gastric bypass procedure. Follow-up was obtained for 86 patients. Average pre-operative weight was 141 kg (BMI = 50). There was an average loss of 55% of excess weight by the second post-operative year. Operative times decreased as the number of the procedures performed by the surgeon increased. Over half of the patients surveyed reported improvements for each of the co-morbid conditions that were assessed (i.e., diabetes, back pain, etc.). Five categories of quality of life were assessed, and over 66% of patients reported improvements in all areas. In 44% of the patients, payment was obtained from private insurance and 56% from Medicare or Medicaid. There were no deaths. Conclusion: Adding bariatric surgery to a general surgeon's practice in the community setting can be beneficial to patients, intellectually stimulating and emotionally rewarding for the surgeon, and economically feasible for the institution.