Private weight-loss surgery clinics shedding quality patient care

Private health clinics across Canada providing weight-loss surgeries are offering much shorter wait times but at a hefty cost and at the expense of quality patient care, according to a new study led by St. Michael's Hospital physician Dr. Chaim Bell.

"The private clinics in Canada offer adjustable gastric banding surgery – a weight-loss procedure that involves banding the upper stomach to restrict food intake– to patients with a median wait time of only one month compared to 21 months in the public health-care system," says Bell. "While this is enticing for patients, our study found 42 per cent of private clinics operated without critical care support and many offered less intense patient care before surgery."

Dr. Bell's team surveyed 30 weight-loss surgery clinics, public and private, across Canada about aspects of care including: wait time for surgery, cost, surgeon experience, number and type of pre and post-operative appointments, location of service and onsite critical care availability. Researchers focused on the two dominant procedures used today: publicly funded Roux-en Y Gastric Bypass — a popular weight-loss surgery that involves stapling the stomach to create a small pouch for food that bypasses a large portion of the stomach — and private adjustable gastric banding surgery.

The findings outline stark differences in wait times, patient eligibility and pre-operative services provided to patients. These include:

• Private clinics offering adjustable gastric banding surgery offer shorter wait times
  
• Adjustable gastric banding surgery at private clinics is costly —$16,000 (median cost)
  
• Some private clinics had information on their websites about the benefits and risks of the weight-loss surgeries that was not consistent with the literature.
  
• Patients in private clinics received less intense pre-operative care – this includes an average of about one and a half fewer visits with multidisciplinary health professionals and specifically fewer visits with internists/endocrinologists and fewer education classes
  
• 25% of private clinics said they had little or no screening process for patients who wanted surgery.

"Surgeons who operate on patients within weeks or even a few months of initial consultation may not be leaving enough time for other additional psychological testing, lifestyle changes and the chance for patients to change their mind," Bell added. "These findings underscore the need for standardization in the field of weight-loss surgery in Canada, including what types of surgeries are offered and which patients are eligible."

The researchers suggest, at minimum, private clinics be monitored to ensure they provide patients with accurate and unbiased information about weight-loss surgery options, and operate safely and with sufficient critical care support. They also recommend setting a wait time target for insured Roux-en Y Gastric Bypass surgery so that all patients have equal access to care.