Blekinge Värmland Norrbotten Jönköping Kronoberg Örebro Skåne Halland SWEDEN Stockholm Västmanland Uppsala Västra Götaland Kalmar Östergötland Sörmland Västernorrland Gotland Jämtland Gävleborg Dalarna Västerbotten
89.5 84.6 83.4 83.4 82.5 82.4 82.2 81.3 79.9 79.9 79.5 79.0 78.5 78.3 78.2 77.0 76.9 75.4 75.2 74.5 72.9 61.3 0
20
40
60
Figure 147
80
100 Percent
2009
Loss of excess BMI one year after bariatric surgery, 2010. Source: Scandinavian Obesity Surgery Registry
No single composite outcome measure has been established for these various treatment goals. This indicator is presented despite the fact that weight loss is not a treatment goal in itself. Nevertheless, at least some of the medical treatment goals correlate with the number of kilogrammes that the patient loses. Moreover, studies have shown that long-term qualify of life improvement requires lasting weight loss of at least 25 kilogrammes, generally half of the excess to start with. This indicator is an internationally established outcome measure for bariatric surgery. The variable is the percentage of preoperative excess weight that the patient has lost one year after surgery. Preoperative excess weight is defined as the difference between the preoperative BMI value and 25. Weight loss (occasionally gain) is the difference between BMI one year after surgery and the preoperative level. The comparison in Figure 147 is based on data for 5 973 patients who underwent surgery in 2010 and whose weight loss was followed up on one year later. Patients who were reoperated on and whose primary surgery was performed prior to start-up of the register were excluded. Patients were assigned to their county of residence regardless of where surgery or follow-up was performed. Only gastric bypass surgery, the method used for 97 per cent of all bariatric procedures in Sweden, was included. For the country as a whole, patients had lost an average of 80 per cent of their excess body weight one year after surgery. The variations among counties were mod302
QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012