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DATO Registry

Dutch bariatric surgery registry aiding acceptance of specialty

A total of 21,941 cases were registered between 2015 and 2016

The Dutch Nationwide Bariatric Quality Registry (DATO) is contributing more valuable knowledge about bariatric surgery and is increasing the acceptance by other health care providers of the benefits of bariatric surgery, according to a paper assessing the initial performance of the registry. The paper, ‘A Dutch Nationwide Bariatric Quality Registry: DATO’, was published in the journal, Obesity Surgery.

According to the authors, from Dutch Institute for Clinical Auditing, Leiden University Medical Center, Leiden, Groene Hart Hospital, Gouda and Catharina Hospital, Eindhoven, the Netherlands, the nationwide Dutch Audit for Treatment of Obesity (DATO) was established in 2014 (coordinated by the Dutch Institute for Clinical Auditing, DICA), to ensure and improve the quality of bariatric surgery. In addition, the registry was also designed to demonstrate transparent clinical auditing not only consisting of clinical outcomes, but also process indicators and patient-reported outcomes.

 The audit, which officially started on 1st January 2015, is overseen by a scientific committee and a clinical audit board (CAB) responsible for monitoring the quality of the registry. The scientific committee represents all 18 bariatric centres and all members are mandated from the practicing hospital where they are employed.

Data outcomes

The first published data from DATO revealed that between 2015 and 2016, a total of 21,634 unique patients were registered in the DATO, with a total record count of 21,941. Of these, 18,784 (85.6%) operations were primary procedures. The mean age was 43.8 years (±11.2 SD), with a median of 44 years. The mean BMI43.3 (± 5.4 SD) and median of 42.3. The largest group of procedures involved patients with a Roux-en-Y gastric bypass (RYGB) (72.4%; n=15,889), followed by gastric sleeve (GS) (17.7%; n=3,885), one anastomosis gastric bypass (OAGB) (5.9%; n=1298) and other procedures (4.0%; n=869). All 18 bariatric centers met the quality indicator regarding a minimum of 100 bariatric procedures per individual hospital, with a range of 171 to 1,153 procedures.

The data also showed that in 2015, 92.1% (n=9,534) of cases had complete records, which increased in 2016 to 94.3% (n= 11,586). In 2015, 95.6% (n=8,371) of the cases met the requirements for bariatric surgery, which increased in 2016 to 96.0% (n=9,625). In 0.8% (n=169) of all registered cases, the BMI were unknown, 2.0% (n= 431) had an unknown presence of any comorbidity and in 0.02% (n=5), the age could not be calculated. In 2016, the lost to-follow-up percentage was 2.04% (n=131) of the 6,433 primary bariatric procedures performed from January to October 2015.

In 2015, ten patients died after surgery, a 30 day mortality rate of 0.1%; compared with six patients (0.05%) who died in 2016. The postoperative (30 day) post-operative complication rate (Grade 4, life- threatening complications requiring intensive care admission) was 0.6% in 2015 and 0.8% in 2016. All complications during admission occurred in 3.0% (n=305) of the cases in 2015 and 2.8% (n=322) in 2016.

“Bariatric procedures were considered relatively safe, regarding to other surgical interventions, where mortality and morbidity were considered acceptable,” the authors noted. “With 16 deaths out of 21,634 unique patients in the past two years, bariatric surgery in the Netherlands can be considered relatively safe…When compared to international literature, the number of serious complications was significantly lower in DATO.”

In 2016, 83.1% (n=5,346) of patients from January to October 2015 reached more than 50% EWL after primary surgery. The group with the highest percentage of >50% EWL was OAGB (86.8%; n=275 followed by RYGB (85.0%; n=4,218), GS (72.3%; n=825), and other procedures (34.5%; n=29). In the same time period, 86.1% (n=5,538) of the operated patients succeeded more than 20% Total Weight Loss (TWL) after primary surgery at the first-year follow-up. The highest percentage of >20% TWL, was measured at OAGB (90.2%; n=286), followed by RYGB (87.2%; n=4,325), GS(78.8%; n=899) and other procedures (34.5%; n=29).

“The Dutch Audit for Treatment of Obesity has become rapidly a mature registry. The well-organized structure of the national audit, the cooperation with DICA, and governmental funding are essential,” the paper concluded. “However, most importantly were the bariatric surgeons themselves: unconditional nationwide participation including very high response for PROMs. The authors believe reporting the results from the registry has already contributed to more knowledge and acceptance by other health care providers, improved quality as each centre got feedback about its performance, and improved discussion with health organisations such as insurance companies about quality and indicators. This provides enthusiasm for the future.”

To access this paper, please click here

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