Long-term follow-up after bariatric surgery in a national cohort.

BACKGROUND: Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. METHODS: All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. RESULTS: Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P < 0.001) and calcium (from 14·4 to 7·7 per cent; P < 0·001), but increased for vitamin D (from 33·1 to 34·7 per cent; P < 0·001). The percentage of patients with one or more visits to a surgeon decreased between the first and fifth years, from 87·1 to 29·6 per cent (P < 0·001); similar decreases were observed for visits to a nutritionist/endocrinologist (from 22·8 to 12·4 per cent; P < 0·001) or general practitioner (from 92·6 to 83·4 per cent; P < 0·001). The mean number of visits to a general practitioner was 7·0 and 6·1 in the first and the fifth years respectively. In multivariable analyses, male sex, younger age, absence of type 2 diabetes and poor 1-year follow-up were predictors of poor 5-year follow-up. CONCLUSION: Despite clear national and international guidelines, long-term follow-up after bariatric surgery is poor, especially for young men with poor early follow-up.

[Bariatric surgery in France: results of a nationwide prospective survey]. / La chirurgie de l'obésité en France: résultats d'une enquête prospective nationale.

AIM: To compare the actual practice of bariatric surgery in France with the guidelines of scientific societies regarding surgical indications and followup. METHODS: This a prospective descriptive transversal study performed within a two month period (December 2002 - January 2003) in all patients for which a consent demand has been sent to the Medical Insurance Services (examined by an administrative consultant) and/or patients operated on for morbid obesity (with or without administrative consent). RESULTS: One thousand and three patients have been examined by an administrative consultant before obesity surgery and 1238 patients have been operated in 263 centres including 79 public (non-profit) centres and 184 private centres. In 16.7 % of the cases, there were wrong indications according to recognized criteria (BMI<35 kg/m(2) or lack of comorbidities for BMI between 35 and 39) or even contraindications because of other diseases. Patient informed consent was retrieved in only 54 % of medical files and follow up protocol was done in only 47 % of the cases. Because of several missing data, the practice of bariatric surgery followed the guidelines in only 34 % of cases. In hospital morbidity rate was 5 %. Two patients died postoperatively (mortality rate 0.2 %). CONCLUSIONS: This study demonstrates that the practice of bariatric surgery needs to be improved in France.

[National Health Insurance expenditures in 1994 for thirty long-term illness]. / Dépenses du Régime général de l'Assurance-Maladie en 1994 pour les trente affections de longue durée.

OBJECTIVE: The health insurance system carried out a survey in 1994 on the illnesses included in the regulations on the thirty long-term illnesses (ALD 30) exempt from patients' contributions to the costs of medical treatment. One of the objectives of this study was to provide the average amount, per patient with these illnesses, of the total expenditures of payments in kind reimbursed by the health insurance system and their distribution by principal expenditure post and by illness. METHODOLOGY: A sample of 67,828 patients was randomly selected at the rate of 2% of the total patients under ALD 30 in November 1994. The expenditures reimbursed over the course of June through November 1994 were collected from a computerized petition on the Health Insurance Information System. RESULTS: The average annual cost per patient within the regulation is estimated at 35,991 FF (+/- 692). Close to half of these expenditures correspond to public hospital stays. The annual expenditures extrapolated from the total ALD 30 is estimated at 143.7 billion FF, or 35% of the total expenditures of payments in kid reimbursed by the health insurance system. "Mental illnesses" represent the largest portion of these expenditures given to ALD 30 (23%). CONCLUSIONS: The survey allows for an evaluation of the average cost per patient covered 100% by the health insurance system under ALD 30. For the majority of these illnesses, these evaluations are the only benchmarks currently available.

[Prevalence of thirty long term disorders for French health insurance members in 1994]. / Prévalence des trente affections de longue durée pour les affiliés au Régime général de l'Assurance Maladie en 1994.

BACKGROUND: The French health insurance has carried out a survey to estimate the medical and social prevalence for the 30 long-lasting affections. This estimation was extended to the instantaneous morbidity prevalence for some of these diseases. METHODS: The random sampling represented 2% of the 3,337,795 patients who were affected by long-lasting affections (ALD 30). To codify the diagnoses, the "médecin conseil" proceeded by different ways: either by examining the patient, by consulting the practicing physician (69% of the patients), or by consulting the individual medical file. Morbidity prevalence estimates were limited to some diseases: those for which correcting coefficients were available or those for which the legislation on long-lasting affections were applied in patients not likely to come under "invalidity". RESULTS: In November 1994, among the patients who came under "ALD 30", 39% were affected with cardio-vascular diseases, about 15% were affected with psychiatric diseases, and a similar proportion presented cancer or diabetes. The estimation of the insulin-dependent diabetes morbidity prevalence was 4.1/1000, non insulin-dependent diabetes 18/1000, progressive rheumatoid polyarthritis 2.8/1000, Parkinson disease 2.0/1000, and multiple sclerosis 0.4/1000. This survey also estimated the prevalence of seven other affections. CONCLUSIONS: This survey provides morbidity prevalence rates estimated on the basis of a representative sample of a sub-population including 70% of the French population. Most results are close to those which have been already published, but some of them appear quite new.