Bariatric surgery revisions and private health insurance

Objective: To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions. Methods: An analysis of patient level admission data from the Integrated South Australian Activity Collection (ISAAC) was performed. Data were collected on all revisions for weight loss related procedures at all South Australian public and private hospitals, between 2000-2015 using the ISAAC codes for revision procedures. Results: 12,606 bariatric procedures occurred in hospitals; ∼27% of which represent a revision (n = 3366). Of these revisions, ∼82% occurred in a private hospital (n = 2771), and ∼18% occurred in a public hospital (n = 595). Of the 595 revisions in a public hospital, 51% of patients had their original bariatric procedure performed in a private hospital. The majority of patients who had a revision procedure are female (≥82%) with a mean age of ∼45. Individuals from the lowest 2 IRSD quintiles were over-represented for public hospital revisions and primary bariatric procedures. Conclusion: Further investigation is needed to identify: 1. Why 27% of bariatric procedures are revisions; 2. Why at least 51% of revisions in public hospitals are on patients whose original primary bariatric procedure was done in a private hospital; 3. The impact that revision procedures in public hospitals, particularly for originally private weight loss procedures, is having on public hospital wait times; 4. The impact of socioeconomic disadvantage on weight loss procedure outcomes.