The procedures have a high success rate and low complications, but pharmaceuticals may be seen as safer and cheaper.
The number of people undergoing bariatric surgery in Australia has fallen to its lowest since 2016, despite its successful outcomes, probably thanks to the popularity of GLP-1 drugs.
The average total weight loss one year after surgery is 29%, according to the Bariatric Surgery Registry, which monitors safety and quality and collects data annually from participants for up to 10 years.
More than half of the recipients with diabetes – who represent only 9% and 15% of female and male recipients – can go without diabetes medication one year after the surgery.
The registry recorded 19,599 procedures during 2023 (this represents about 80% of all procedures actually done, it says) of which 15,985 were primary procedures and 3614 were revisions.
Nearly 80% of recipients were female and the average age was 42, with the most common age for women being early 30s and men early 40s.
All but 5% of the operations were performed in the private system.
Sleeve gastrectomies were by far the most popular type, accounting for 80% of surgeries; 11% were one anastomosis gastric bypass and 9% were Roux-en-Y gastric bypass.
Since it was established, the registry has recorded 62 deaths within 90 days of bariatric surgery out of about 180,000 procedures.
Adverse events after primary procedures are rare, with a rate under 2% for sleeves and under 5% for gastric bypasses.
Evidence of a drop in numbers comes from the Medicare Benefits Schedule, which recorded a total of 21,044 procedures in calendar year 2023, the lowest since 2016’s 18,980.
The registry’s clinical lead Professor Wendy Brown, head of Monash University’s surgery department and director of the Alfred’s oesophago-gastric-bariatric unit, said the drop in numbers could be due to the availability of pharmaceutical options with similar outcomes, or the cost-of-living crisis.
“There has been significant uptake of very effective pharmaceuticals that provide weight loss that is similar to bariatric surgery at one year,” Professor Brown said.
“It may be that practitioners and patients are opting for non-surgical pharmaceutical options rather than surgery.
“We are also facing significant cost of living challenges, meaning that the cost of surgery now might be prohibitive for some, or people may fear being away from work when their job is under threat.”
The more marked drop in revision surgeries, which may be sought if the desired weight loss is not achieved, suggested people were choosing medications “rather than more aggressive surgery when metabolic bariatric procedures are no longer providing the required weight loss”, Professor Brown said.
“This is a pattern we will continue to monitor in years to come.”
