2015 ASMBS Bariatric Surgery Report

[Alex Brecher 10,516]

American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States

The ASMBS Bariatric Numbers task force is reporting the 2015 estimation of the number of bariatric surgery procedures in the United States.

This is a yearly report numbers estimation, and the task force followed the same methodology as in previous years [1]. A comprehensive review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was performed, which included 100% of the primary and revisional bariatric cases performed within accredited metabolic and bariatric surgery centers. It was noted that during the 2015 calendar year, 89 new centers submitted data in comparison to 2014, and these centers submitted data on 8110 cases. These new accredited centers led the estimation of the number of cases performed in inpatient nonaccredited facilities to drop to more than half of what was estimated in 2014. Bariatric Outcomes Longitudinal Database (BOLD) and other data- bases were reviewed as well.

To capture outpatient procedures performed at centers that do not submit data to MBSAQIP or BOLD, device maker companies were surveyed to obtain the total number of gastric bands and intragastric balloons sold per year; however, an estimation was made to deduct devices purchased but not used. Large outpatient centers performing stapling procedures, mainly laparoscopic sleeve gastrectomies, also were surveyed.

The 2015 numbers listed in Table 1 show stability in the total number of bariatric procedures compared with 2014. The sleeve gastrectomy continues to be the most common procedure. Continuing the same trends as previous years, the gastric bypass decreased slightly, and the gastric band continued to decrease significantly. Numbers of revisions now are close to 1 out of 7 cases performed, predominantly gastric band conversions to stapling procedures.

According to the 2015 projections from the U.S. Census [2] the total population of the United States was 321,418,820, of whom 247,773,209 were adults aged 18 years or older. Using the obesity prevalence data (body mass index Z40; 6.4% of adults) [3] 15,857,485 estimated individuals qualified for bariatric surgery. Thus, the rate of bariatric surgery in the qualified population based solely on body mass index criteria in 2015 is estimated at 1.24%. When analyzing only the numbers of primary procedures compared with the number of “eligible” candidates, the penetration rate of surgery in the candidate population in 2011 was .976% and increased to 1.068% in 2015. Over the 5-year period between 2011 and 2015, these data suggest that the penetration rate of surgery in the “eligible” population increased by an annual average of only 1.9% (number of primary procedures per eligible candidate).

Regarding the bariatric surgeon workforce in the United States, it is difficult to estimate the number of surgeons performing bariatric procedures. The following calculations assume that practicing bariatric surgeons in the United States are active surgeon members of ASMBS. This assumption likely underestimates the number practicing by an unknown number. However, other available estimates of the number of practicing bariatric surgeons provide lower numbers. For example, the American College of Surgeons’ directory includes 1271 surgeons who self-identify as performing bariatric procedures [4]. A search of the MBSAQIP directory identified 1300 surgeons who perform bariatric procedures [5]. If these lower numbers are more accurate, then the following calculations would require proportionate adjustments downward.

ASMBS has 1810 active surgeon members. Regarding gender of active members, 1643 are male and 167 (9%) are female. Similar to statistics regarding the dramatic growth in numbers of female surgery residents in the United States [6], female active members comprise 20% of the member- ship between age 30 and 39, but only 4% of the member- ship age 50 years and older. ASMBS reports 54 surgeons currently comprise the candidate group for membership, although in recent years this number is more typically 75 surgeon candidate members per year. This number of annual membership candidates would expand the active membership by 4.1% per year. This corresponds closely to the number of fellowship training positions offered each year by the Fellowship Council in the United States [7]. Currently in the United States 61 postgraduate fellow- ships provide training in bariatric surgery for up to 77 trainees on an annual basis. Of these 61 programs, 29 are classified as bariatric fellowships, 31 as minimally invasive surgery/bariatric fellowships, and 1 program is categorized as minimally invasive surgery/bariatric/flexible endoscopy.

The bariatric surgeon workforce is also influenced by the number of retiring surgeons. Williams and Ellison studied the general surgeon workforce in 2008 [8]. They suggested that the typical surgeon practices for 30 years, and therefore it is reasonable to estimate that 1/30th or 3.4% of surgeons retire each year. An annual retirement rate of 3.4% would translate into 62 ASMBS active surgeon members retiring each year. Another method to estimate the number of retiring surgeons is to examine the age distribution of current ASMBS members. Thirty active members (1.7%) are over the age of 70 years and could be considered imminent candidates for retirement, while 142 active members (9.4%) are over the age of 60 years and may retire in the next few years. Assuming ASMBS members age 60 and older will retire at an equal rate each year over the coming 5-year period would suggest that 34 surgeons will retire annually over the next 5 years. Thus, using these 2 approaches to estimate the number of active bariatric surgeons retiring each year, one would estimate that between 34 and 62 bariatric surgeons will retire each year.

Conclusions

There has been a 24% increase in the absolute number of procedures performed annually in the United States since 2011. However, surgery is chosen/achieved as a treatment option by only 1% of candidates as defined by the estimated number of patients with class III obesity. The penetration rate of surgery in patients with class III obesity is estimated to have grown by only 9.4% over 5 years for an annual growth rate of 1.9%. Thus the increased number of procedures may simply result from the ongoing growth in the U.S. population.

The bariatric surgeon workforce is difficult to estimate, but there appears to be similar small growth in the number of bariatric surgeons based on ASMBS membership data and assumptions regarding surgeons retiring from practice. The active surgeon membership of ASMBS appears to be increasing by between 13 and 41 surgeons each year, or .7% to 2.3% per year. This growth in surgeon workforce appears reasonable given the growth noted in absolute procedure numbers. Bariatric surgery, as the only successful long-term treatment for obesity, continues to be under- utilized in treating the obesity epidemic in the United States.

References

[1] Ponce J, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg Obes Relat Dis 2015;11(6):1199–200.

[2] United States Census Bureau. American FactFinder website. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2015 [cited 2016 Aug 15]. Available from: http://factfinder.census.gov/faces/tableservi ces/jsf/pages/productview.xhtml?pid=PEP_2015_PEPANNRES&src=pt.

[3] Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief 2015;(219):1–8.

[4] American College of Surgeons website. Searching for surgeons [cited 2016 Aug 15]. Available from: https://www.facs.org/search/find-a-surgeon.

[5] American College of Surgeons website. Metabolic and bariatric surgery accreditation and quality improvement program [cited 2016 Feb 15]. Available from: https://www.facs.org/quality-programs/mbsaqip.

[6] Association of Women Surgeons website. Why AWS is important [cited 2016 Feb 15]. Available from: https://www.womensurgeons.org/ about-us/why-aws-is-important/.

[7] The Fellowship Council website. Directory of fellowships [cited 2016 Feb 15]. Available from: https://fellowshipcouncil.org/directory- of-fellowships.

[8] Williams TE Jr, Ellison EC. Population analysis predicts a future critical shortage of general surgeons. Surgery 2008;144(4): 548–554; discussion 554–6.

[eliminnowp 113]

I love data. Thanks for sharing this.

Sent from my SM-J700P using the BariatricPal App

[ShelterDog64 2,364]

I'm a data hound, too, thanks for posting this Alex

[4MRB4PHOTO 3,900]

I'm a data hound, too, thanks for posting this Alex

You are more like a "data doberman".

(from your present avatar picture -in case someone reads this at a later date if you change it)

[ShelterDog64 2,364]

I'm a data hound, too, thanks for posting this Alex

You are more like a "data doberman".

(from your present avatar picture -in case someone reads this at a later date if you change it)

Then I'm actually a 'data miniature pinscher who thinks he's a doberman'

[4MRB4PHOTO 3,900]

I'm a data hound, too, thanks for posting this Alex

You are more like a "data doberman".

(from your present avatar picture -in case someone reads this at a later date if you change it)

Then I'm actually a 'data miniature pinscher who thinks he's a doberman'

That's what I get for viewing this on a tablet. I was trying to build up your dog's self esteem.