IFSO publishes Second IFSO Global Registry Report

The Second IFSO Global Registry Report (2016) has been released at the XXI World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) in Rio de Janeiro, Brazil. Published by Dendrite Clinical Systems, under the auspices of the IFSO, the publication reports data on baseline obesity-related disease, operation types, operative outcomes and disease status after bariatric surgery in over 140,000 patients accumulated from 31 local and national databases and registries from all over the world.

Global IFSO Registry Project

The report is the culmination of years of research and analyses from the IFSO Global Registry Project, which was established in January 2014 to demonstrate that it is possible to merge and analyse bariatric and metabolic surgical data from different countries and centres.

Natan Zundel

“After a successful Pilot Project, the IFSO Executive Council took the formal decision to fund a Global Registry in 2014, and this Second Report is the next logical step from the pioneering work of Drs Scopinaro, Buchwald, Angrisani, Weiner and others in their surveys of national society members from within the Federation,” explained Professor Natan Zundel, President of IFSO. “It is the next important step in describing and comparing the baseline characteristics and operative outcomes in large numbers of patients as we build up a more and more representative picture of what is happening around the world.”

This latest report includes 141,748 operation records from 31 countries and from five continents, and has detailed information on 82,264 gastric bypass operations (58% of all the records submitted), 36,263 sleeve gastrectomy procedures (25.6%) and 13,824 gastric banding operations (9.8%).

The publication has some fascinating county-to-country analysis and notes a wide variation in the gender ratios of patients having surgery, ranging from 54.2% female (in Brazil) to 80.3% female (in the Netherlands). The report also highlights funding inequality and an inequality of access to surgical services with 58.3% of operations funded by public health services, with a variation in the rates of publicly-funded surgery across the contributor countries (proportion female range: 0.0-96.9%). The report also noted a wide variation in the patients’ average BMI pre-surgery from 36.6 in Peru to 49.1 in Ireland (average 44.7).

“We believe that this initiative is an important part of the global response to the obesity epidemic,” added Professor Zundel. “We would like to offer our sincere thanks to all those who have submitted their data so far. Personally, I truly believe that when you see the final product of these endeavours, all of you will not only benefit for this information, but also will want to join this journey towards a truly Global Registry, which will ultimately be to the benefit of our patients. Therefore, we would like to encourage all national societies and individual surgeons to actively participate in the next iteration.”

On a country basis, there are marked differences in procedure type with centres submitting data from Switzerland (100.0%), Sweden (92.8%) and Mexico (86.7%) recording the highest proportion of gastric bypass operations and those submitting data from Peru (100.0%), Saudi Arabia (100.0%) and Qatar (100.0%) reported the highest rates of sleeve gastrectomy operations. Unsurprisingly, 97.8% of all procedures were performed laparoscopically.

A limited number of copies of The Second IFSO Global Registry Report will be available to IFSO members at XXI IFSO World Congress. To collect your copy, please visit Dendrite Clinical Systems at Stand 33 in the Exhibition Hall

Outcomes

Follow up data for primary surgery found that the average percentage excess weight loss was 72.4% one year after surgery and the corresponding percentage weight loss was 30.4% one year after surgery. In addition, one year after primary surgery 64.7% of those taking medication for type 2 diabetes prior to surgery were no longer on medication and the proportion of patients no longer treated for diabetes was highly dependant on weight loss achieved. There were also significant reductions in the rates of treatment for depression, hypertension and musculo-skeletal pain, with rates of confirmed sleep apnoea and GERD also falling one year after bariatric surgery

Other highlights of the report show:

• 88.1% of patients who had a gastric band inserted were discharged within one day of their operation, compared with 75.4% of gastric bypass patients who were discharged within two days of surgery (86.8% of patients went home within three days of their operation)
• 22.0% of patients were on medication for type 2 diabetes (inter-country variation: 7.4-63.2%), 31.9% were treated for hypertension (inter-country variation: 15.8-92.7%), 17.6% of patients were on medication for depression (inter-country variation: 0.0-46.3%), 27.8% of patients required treatment for musculo-skeletal pain (inter-country variation:0.0-58.9%), 18.9% of patients had sleep apnea (inter-country variation:0.0-63.2%) and 29.6% of patients had GERD (inter-country variation: 9.1-90.9%)
• The Obesity Surgery Mortality Risk Score (OSMRS) varied widely by country with Turkey, Ireland and Hong Kong reporting the highest-risk patient populations (OSMRS groups B & C: 57.9%. 56.9% and 55.1% respectively) and Peru, the Netherlands and Panama reporting the least risk (OSMRS groups B & C: 22.2%,
• 23.9% and 26.0% respectively)

Kelvin Higa

“It is not feasible to rely upon a single practice to keep track of every patient forever. By contrast it is possible for a health care system to keep track of every patient who has had a bariatric/metabolic procedure and this should be among the highest of priorities,” states Kelvin Higa, President Elect of IFSO, in the foreword of the report. “The IFSO Global Registry is an important step in this direction. Every surgeon who performs a bariatric / metabolic procedure should consider participation a mandatory part of this specialty.”

Richard Welbourn

“The data presented are not intended to be a definitive global representation of bariatric surgery, as data from many countries with large volumes of surgery are not yet included,” writes Mr Richard Welbourn in the introduction of the report. “However, the report is the start of a process that shows what can be achieved within the constituent countries of IFSO. For instance, the data could in future be used to estimate inequalities of provision of surgery internationally, and provide benchmarks for access to surgery to those people with specific obesity-related disease such as diabetes. Thank you to all those surgeons who have committed their data for inclusion in this second report, your contribution is very much appreciated.”

Mr Welbourn will present the report for the first time on Friday 30th August at the XXI IFSO World Congress.

“Together with IFSO, we are delighted to publish this second report. I would like to thank all the contributors for submitting their data,” said Dr Peter Walton, Managing Director of Dendrite Clinical Systems. “I hope this important publication not only suggests many international research projects that could be undertaken, but advances the status and acceptability of bariatric surgery worldwide, helping promote an increase in bariatric and metabolic surgery provision.”

The Global IFSO Registry Pilot Project was headed by Mr Richard Welbourn (UK), John Dixon (Australia) Kelvin Higa (United States), Johan Ottosson (Sweden), Almino Ramos (Brazil), Bart van Wagensveld (The Netherlands), Rudolf Weiner (Germany), Natan Zundel (Colombia), Dr Peter Walton (Dendrite Clinical Systems) and Dr Robin Kinsman (Dendrite Clinical Systems).