Time trends in obesity surgery 1987 through 1996 in Sweden - A population-based study

Background:The Swedish health-care system is well suited for surveys of inc idence of surgical procedures including those for morbid obesity, since alm ost all hospital care is provided by public hospitals funded by a public he alth-care insurance system. The National Board of Health and Welfare keeps a nation-wide registry of all in-patient hospital care. In order to describ e the practice of obesity surgery, we extracted data for all patients who h ad undergone obesity surgery between 1987 and 1996. Material: 6,339 patients had at least one obesity surgery procedure between Jan. 1987 and Dec. 1996. A total of 7,176 procedures were identified. 77.2 % were women, and the mean age was 39 years. Hospital stay averaged 8 days. Results: There was a 3-fold increase in the annual incidence from 312 proce dures/year in 1987 to 952 in 1996. 14% of the patients operated in 1996 had previously undergone obesity surgery during the study period. The hospital mortality was 0.4%. Simple gastric restrictive procedures dominated (76%), and gastric bypass and jejuno-ileal bypass were performed in 7.5% and 5%, respectively. There was a trend that gastric bypass was performed more freq uently towards the end of the study period. An increased number of procedur es were performed in smaller hospitals during 1994-96, and there were obvio us geographical variations. Conclusion:There has been 3-fold increase in obesity surgery in Sweden betw een 1987 and 1996, accounted for by increased performance of simple gastric restrictive procedures. The operative mortality is low, but the incidence of a second obesity surgery procedure is high.