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Access to Bariatric Surgery in Canada

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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  1. Access to Bariatric Surgery in Canada Nicolas V. Christou MD PhD Professor of Surgery McGill University

  2. 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

  3. 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?”

  4. Accès aux services médicaux spécialisés Méthodologie générale

  5. 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.

  6. MUHC Bariatric Surgery Wait times As of January 31 2012

  7. When does the “official” wait for bariatric surgery clock start ticking? Christou et al Can J Surg. 52:229-234, 2009

  8. Overall wait times for bariatric surgery in Canada Christou et al Can J Surg. 52:229-234, 2009

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

  10. Canadian Bariatric Surgery yearly volumes compared to the rest of the world (2011) USA volume ~ 210,000

  11. 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!

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Quebec Bariatric Surgery (all types)

  19. 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

  20. LAGBD Safe in Private Clinics Coburn et alObesity Surgery (2009)

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

  22. 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

  23. 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

  24. Results 1

  25. Results 2

  26. Ontario Bariatric Registry: Surgery Projections Projections for Number of PUBLIC + PRIVATE (AGBD) Surgeries performed in Ontario: Source: Various private clinics and OBN

  27. Total Number of Surgeries Performed by the McGill Bariatric Group

  28. 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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