Surgical management of obesity in Brazil

Dr. Ricardo Cohen


A novel value-based bariatric surgery program sustained by 1-year results of early postoperative favorable outcomes.


Bariatric surgery is especially suitable for value-based initiatives. The surgical management of obesity, which affects an increasing number of individuals worldwide, requires multidisciplinary approaches, including physical and psychosocial assessments, weight loss interventions, and long-term follow-up. All of these could be delivered as separate services or, in a VBHC context, as an integrated bundle. Because of the factors listed above, bariatric surgery has been used to model the development of VBHC programs.

The greatest challenge is how to implement and measure the benefits of a value-based model approach. Our initiative describes the implementation and one-year outcomes with a novel value-based bariatric surgery program in Brazil.

Our initiative was carried at a private hospital in São Paulo, Brazil (Hospital Alemão Oswaldo Cruz, Vergueiro Unit). A value-based healthcare (VBHC) program was implemented, with the design of an episode of care and development of a bundled payment model for bariatric surgery. The following 30-day outcomes were assessed: complication rate, length of stay (LOS), intensive care admissions, reoperations, readmissions, and visits to the emergency department.

Results were compared to real-world evidence retrieved from a Brazilian private insurance database containing information on bariatric procedures performed in similar institutions (benchmark group). The outcomes in the VBHC group were also analyzed regarding clinical endpoints of type 2 diabetes mellitus (T2DM) and hypertension.

Eighty-three patients were enrolled in the VBHC program (80.7% females; 18.0% with T2DM; 31.0% with high blood pressure). Mean age was 40.9 years, and body mass index (BMI) was 42.1 kg/m . The following

30-day outcomes were recorded in the benchmark group vs. VBHC group: complication rate, 2.6% vs. 1.4%; LOS, 2.5 vs. 2.0 days; intensive care admissions, 4.0% vs. 1.2%; reoperation, 1.8% vs. zero; readmission, 2.3% vs. zero; and patients seeking emergency care, 15.0% vs. 6.0%.

These initial results showed favorable 30-day outcomes demonstrating benefits of value-based approach for the surgical management of obesity.