Authors' objectives:

In 1998, the Conseil d'evaluation des technologies de la sante (the predecessor of AETMIS) published a report on the surgical treatment of morbid obesity. The need to clarify the status of biliopancreatic diversion with duodenal switch (the procedure used in Quebec), the rapid expansion of laparoscopic techniques and the growing prevalence of morbid obesity are the reasons for this update. This report also responds to a request from the Ministere de la Sante et des Services Sociaux (MSSS) asking AETMIS to examine the evolving efficacy of bariatric-surgery techniques and the best conditions for managing people with severe obesity. Lastly, this assessment explores the economic aspects of this treatment.

Authors' recommendations: 1) It is recommended that the MSSS and other decision makers concerned with the problem of morbid obesity precisely identify current and future needs in bariatric surgery, establish an action plan to increase the capacity to provide this treatment, and ensure that patients in the different settings and regions have fair access to these services. 2) It is recommended that, at the organizational level, all hospital bariatric-surgery programs comply with the conditions listed below, which will be subject to a quality-assurance process. Such programs must: - Establish a strict patient-selection process (e.g., patients who have BMIs of 40 kg/m2 or more, or 35 with co-morbidities, who have acceptable operative risks, who are motivated and well informed of the inherent risks of the procedure and of the need for lifelong follow-up) and a system for prioritizing patients on scheduled waiting lists. - Have available facilities and equipment adapted to the specific profile of the patients concerned (e.g. recovery rooms, intensive-care units, beds and furniture, diagnostic investigation tables, operating tables, and adapted surgical instruments). - Have an experienced multidisciplinary team capable of supplying the full range of care and services tied to this type of treatment: surgical team, psychologist, nutritionist, medical specialists (e.g., diabetologists, cardiologists, pneumologists). - Provide closely monitored lifelong follow-up, and cover the physical and psychological dimensions of this treatment, which consequently includes consultations linked to the need for plastic surgery. 3) It is recommended that a Quebec registry on morbid obesity and its management be established. This registry will offer key support in implementing a regional follow-up program for operated patients by linking the different healthcare structures (hospitals, health centres) and by including specific patient education on nutritional approaches appropriate for this type of patients. This data source will make it possible to determine the prevalence and categorization of the different patients, to evaluate the surgical procedures that are currently being performed and to rule on the new bariatric-surgery approaches.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)