Bariatric Surgery in France : Actual State

Bariatric surgery is increasing in France, with a threefold augmentation of interventions since 2006, realized in numerous centers. Majority of them are small and data are often unavailable. We analyzed PMSI data (from 2007 to 2012) and CNAM data delivered in 2013. The HAS reviewed indications for bariatric surgery in 2009. Patients presenting with BMI higher than 40 kg/m² or higher than 35 kg/m² with associated comorbidities can be operated after an adequate medical management. Little variations exist in BMI and comorbidities repartition during this period. Thus, in patients who underwent bariatric surgery in 2013, 70% had BMI higher than 40 kg/m², 26% presented with an arterial hypertension, 11% with type 2 diabetes mellitus, and 10% with a respiratory comorbidity. Total number of interventions increased threefold between 2006 and 2013, specifically Sleeve Gastrectomies, which represented 56% of bariatric surgery activity in 2013. In 2013, 433 centers performed bariatric surgery. Among them, a third realized less than 30 operations per year. Global mortality after bariatric surgery decreased between 2006 and 2013. Mortality rate was divided by three during this period. Early mortality rate was 0.19%. Three years mortality was 0.69%. Mortality risk factors have been identified: age, sex, associated comorbidities (arterial hypertension, diabetes mellitus), BMI higher than 50 kg/m², performing Gastric ByPass or Sleeve Gastrectomy (compared with adjustable gastric banding), open surgery and performing few interventions (less than 25 per year). Bariatric surgery is increasing in France, with a threefold augmentation of interventions since 2006 and a decreased mortality. This activity is performed in numerous centers, a third of them performing less than 30 interventions per year.