Guideline compliance in bariatric surgery: a French nationwide study.

BACKGROUND: Strict adherence to guidelines with a comprehensive preoperative assessment and rigorous follow-up are essential to improve postoperative and long-term outcomes of bariatric surgery (BS). OBJECTIVES: To investigate the trends in BS in France and to assess the compliance to guidelines in people with obesity before and after BS. SETTING: University Hospital of Bordeaux, France. METHODS: Data on patients who were admitted for a primary BS procedure in France between January 1 and April 1, 2014, were extracted from the French national health insurance system database. Data on patients' characteristics, preoperative assessment, hospitalization, and postoperative follow-up, including medical consultations, laboratory tests, and drug consumption, during the year preceding and the 2 years after BS were collected. RESULTS: Most of the 11,824 patients (60.4%) had sleeve gastrectomy. Rates of reimbursement for preoperative consultations with general practitioners, digestive surgeons, and endocrinologists or internists were 94.5%, 89.2%, and 63%, respectively. Laboratory tests for nutritional and obesity-related co-morbidity evaluations were performed in 94.3% and 91.4%, respectively. Rates of consultation with general practitioners, digestive surgeons, and endocrinologists or internists dropped from 93.1%, 91.2%, and 29.2%, respectively, the first year to 88.4%, 50.3%, and 20%, respectively, the second year after BS (P < .001). Reimbursements for vitamin, iron, and calcium supplementation dropped from 66.6%, 24.9%, and 21%, respectively, the first year to 52.1%, 19.3%, and 11.7%, respectively, the second year after BS (P < .001). CONCLUSION: Overall compliance with guidelines is improving. While preoperative medical assessment is nearly optimal, efforts still should be made in order to improve long-term follow-up in general and patient adherence to micronutrient supplementation in particular.

[The treatment of age-related macular degeneration (AMD) in practice]. / Indications et traitement de la dégénérescence maculaire liée à l'âge (DMLA) en pratique.

AIM: The purpose of this paper is to describe and analyze the diagnosis and treatment of age-related macular degeneration (AMD) based on current guidelines. METHODS: A study was conducted on a sample of French AMD patients covered by the RSI (public health insurance for self-employed workers), who received a first reimbursement in 2008 for treatments including verteporfin (Visudyne®), pegaptanib (Macugen®) and/or ranibizumab (Lucentis®). Data were collected retrospectively from the ophthalmologist by the medical adviser. Treatments were compared with the marketing authorisation for AMD drugs and therapeutic indications. Complementary examinations were also examined based on the recommendations of the Haute Autorité de Santé (HAS). RESULTS: 184 patients were included in the sample. Lucentis® was used in 91.8% of cases. 62.0% of the patients treated with Lucentis® had subfoveal CNV. Visual acuity was good in 83.5% of cases. Fluorescein angiography (recommended by the HAS before treatment initiation) was performed in 87.5% of cases. CONCLUSION: The gap between guidelines and practice is illustrated by the case of Lucentis®, which is increasingly used for indications other than those reimbursed by health insurance. The findings indicate that the current price does not reflect sales volume estimates based on current guidelines, a problem that may be compounded by the recent extension of indications covered by health insurance.