Access to bariatric surgery in canada
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Access to Bariatric Surgery in Canada. Nicolas V. Christou MD PhD Professor of Surgery McGill University. Bariatric Surgery at McGill 1963 - . Dr. Carl Nohr. Dr. Henry Shibata. Dr. L.D. MacLean. Dr. APH McLean. Dr. Harry Shizgal. Dr. Nicolas V. Christou. Dr. Olivier Court.

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Access to Bariatric Surgery in Canada

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Access to Bariatric Surgery in Canada

Nicolas V. Christou MD PhD

Professor of Surgery

McGill University

Bariatric Surgery at McGill1963 -

Dr. Carl Nohr

Dr. Henry Shibata

Dr. L.D. MacLean

Dr. APH McLean

Dr. Harry Shizgal

Dr. Nicolas V. Christou

Dr. Olivier Court

Dr. R. Armour Forse

Dr. Rae Brown

Recent Call From The DPS Office - MUHC

“Say Nick, the Minister of Health wants to know the wait time for bariatric surgery at the MUHC. The admissions office told me that you and Olivier have 82 patients on SIMASS, so can I tell them less than 1 year?”

Accès aux services médicaux spécialisés Méthodologie générale

Accès aux services médicaux spécialisés Méthodologie générale

SIMASS - Système d'information sur les mécanisme d'accès aux services spécialisés

L'entrée des données se fait en temps réel par le personnel attitré à ces fonctions dans chacun des établissements du Québec. Une mise à jour trimestriel du site internet est faites à partir de ces données. Patients en attente d'une chirurgie:À partir du 1er juin 2007, toutes les nouvelles demandes de chirurgie ont été saisies dans SIMASS. De plus, tous les patients qui étaient en attente avant cette date et qui n'avaient pas été opérés, ont été inscrits dans SIMASS au 31 octobre 2007.

MUHC Bariatric Surgery Wait times

As of January 31 2012

When does the “official” wait for bariatric surgery clock start ticking?

Christou et al Can J Surg. 52:229-234, 2009

Overall wait times for bariatric surgery in Canada

Christou et al Can J Surg. 52:229-234, 2009

CIHI Survey: Bariatric Surgery in Canada, Arkinson et al HealthC Q 13(2):13-17, 2010

Canadian Bariatric Surgery yearly volumes compared to the rest of the world (2011)

USA volume ~ 210,000

Estimates for Bariatric Surgery Needs of Canadians

  • ~ 1 million Canadian Adults are Morbidly Obese

  • Assuming 5% request Bariatric Surgery

  • Immediate need ~50,000 cases

  • At current capacity estimated at ~5,000 cases per year

  • Over 10 Years to Clear backlog!

What changes to our current Health Care System are required to increase availability of bariatric surgery in CANADA?

  • More money to current system

  • Same money but increase efficiency

  • Money follows the patient model

  • Private health care sector to do more

First Canadian Summit on Surgery for T2DM

OHTAC REPORT “Key Points” Jan. 2005

  • Cost-effectiveness of Bariatric surgery in Rx of morbid obesity related co-morbidities in particular Diabetes

  • Estimated 3-4,000 per year required surgical Rx

  • Increasing trend for Out of Province referral

  • Need to establish Bariatric Centers in Ontario

  • Need to educate the public AND Physicians

“Money Follows the patient” model

Bariatric Centers of Excellence

Four (4) Centers of Excellence:

  • Hamilton Bariatric Centre of Excellence (St. Joseph’s Healthcare Hamilton)

  • University of Toronto Collaborative Bariatric Surgery Program:

    • Humber River Regional Hospital

    • The Hospital for Sick Children

    • Toronto East General Hospital

    • St. Michaels Hospital

    • St. Joseph’s Health Centre

    • University Health Network’s Toronto Western Hospital Site

  • Guelph General Hospital

  • The Ottawa Hospital

    Three Regional Assessment and Treatment Centre:

  • Hamilton

  • Windsor

  • Thunder bay

Principles of Funding

  • Activity based Funding

    • Cost per case calculated by lead centre ($17,000 per case)

    • Adequate hospital overhead

    • Academic stipends for non-clinical work

  • Only a small amount of capital cost for renovations per site

    • Other sources for bariatric CTs and equipment

  • OHIP reimbursement adjusted

    • For surgeons and physicians

Ontario Bariatric Registry

Projections for Number of Surgeries performed in Ontario:

Source: Ministry of Health and long-term care, Nov. 17/09 presentation

Source: M. Anvari , personal communication June 7th 2012

Quebec’s Response to AETMIS Report

Le ministre Bolduc dévoile un plan d’action en chirurgie bariatrique à Lachine

Un investissement de trois millions $ pour un appareil de résonance magnétique

par Robert Leduc

Article mis en ligne le 20 mai 2009 à 15:13

Yves Bolduc, ministre de la Santé et des Services sociaux, a annoncé vendredi dernier à l’Hôpital de Lachine, un plan d’action en chirurgie bariatrique pour traiter les cas d’obésité morbide, en compagnie du député François Ouimet, du Dr Arthur Porter et de Josée Roy

Quebec Bariatric Surgery (all types)

CMAJ – CommentaryTreating severe obesity: morbid weights and morbid waits

“However, governments and administrators of health care systems need to critically examine gaps in care delivery and increase funding accordingly.

A marked increase in the private delivery of bariatric surgery in Canada, as it currently exists, is unlikely to be a viable care model. Private centres often select patients without co-morbidities for surgery, specialize in a single procedure or device, are ill-equipped to deal with complications and revisions, and are poorly positioned to provide life-long follow-up (e.g., for repeat gastric band adjustments).

Therefore, funding is best allocated toward creating new programs and enhancing the capacity of existing programs for bariatric surgery that provide comprehensive, continuing care.”

Padwal RS, Sharma AM, CMAJ (2009):181, 777-78

LAGBD Safe in Private Clinics

Coburn et alObesity Surgery (2009)

A unique situation in Québec(Projet Pilote - Ministère Couilliard 2006)

Secondary Health Care Center (SHCC)

  • 17 bed accredited hospital

  • 3 operating rooms

  • No ICU

  • Dedicated, constant anesthesia and nursing teams

  • 1:3 nurse patient ratio

  • Continuous O2 Saturation monitoring

  • Dedicated “Service corridor” to tertiary health care center

Tertiary Health Care Center (THCC)

  • 583 bed tertiary care hospital

  • 12 operating rooms

  • 18 bed ICU

  • Variable anesthesia and nursing teams

  • 1:??? nurse patient ratio

  • Limited O2 Saturation monitoring

  • Surgeon the only constant

Results 1

Results 2

Ontario Bariatric Registry: Surgery Projections

Projections for Number of PUBLIC + PRIVATE (AGBD) Surgeries performed in Ontario:

Source: Various private clinics and OBN

Total Number of Surgeries Performed by the McGill Bariatric Group

We must improve access to bariatric surgery in Canada because:

  • Obesity associated diseases get worse

  • Cost of treating them goes up

  • Indirect costs also rise

  • Patients are dying while waiting

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