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New Bariatric Surgical Program Established at University of Toronto

Richard Reznick
Richard Reznick


About two years ago, I had an informal meeting in my office with Laz Kline and John Hagen from Humber River Regional Hospital (HRRH) and Lloyd Smith from St. Joseph's. We spent our time discussing the current state of affairs with respect to surgery for morbid obesity in the Province of Ontario. And it was not a pretty picture. Laz, John and other colleagues from HRRH were performing about 250 cases per year, having been designated by the government as a provincial centre of excellence. But despite this accomplishment, other centres, like St. Joe's had not received any funding to treat these patients and over 1500 patients per year were exiting Ontario for their surgery at great cost to our health system. John and Laz's wait times were staggering and approached two years. Further, there has been mounting, and now overwhelming evidence that gastric bypass surgery can be a life-saver, with a dramatic positive impact on diabetes, hypertension, lipid disorders, coronary artery disease and mental health. This impromptu conversation lead to the formation of a working group as we theorized that if we could use the collective power of our teaching hospitals across the University of Toronto, we could possibly achieve the number of cases needed to have a real impact on the Ontario problem, not overwhelm any one hospital and provide a platform for training and research into this important area.


Despite the fact that it is not usual for the University to take a political lead in clinical matters, in this case it made sense; and what resulted was a tremendous spirit of cooperation between our teaching hospitals and our Department of Surgery at U of T, ultimately resulting in the tabling of a proposal to the Ministry. And they agreed! MOHLTC has recently approved funding to establish a large bariatric surgery program at the University of Toronto, which is great news for our university, the affiliated hospitals involved in this initiative, and most of all, the growing ranks of Ontario patients who will significantly benefit from weight loss surgery. The Ministry has earmarked a total of $75 million to expand bariatric surgery capacity in the province, as part of its wide-ranging diabetes strategy. Recognizing the magnitude of the need for this surgery that exists in the Greater Toronto Area, the tremendous surgical expertise concentrated in Toronto, and the University of Toronto's reputation for excellence in health research and education, the Ministry agreed to further expand capacity in Toronto. Other provincial Centres of Excellence in bariatric surgery include Guelph General Hospital, The Ottawa Hospital, and St. Joseph's HealthCare Hamilton.

The new University of Toronto Collaborative Bariatric Surgery Program will be a partnership with Humber River Regional Hospital, University Health Network's Toronto Western Hospital, St. Michael's Hospital, St. Joseph's Health Centre, Toronto East General Hospital, and The Hospital for Sick Children. The rapid creation of a dispersed surgical program such as this one would not have been possible without the trust and belief in teamwork that already exists in the University of Toronto's surgical community.

To date, the province has provided the University of Toronto Collaborative Bariatric Program with over $3 million in capital funding for specialized equipment, instrumentation, inpatient area renovations, and the creation of an ambulatory obesity clinic. Once this program is fully functional, operational funding will total almost $12 million per annum. This money will cover supplies, clinical support service, and inpatient and clinic staffing costs.


A cornerstone of the collaborative bariatric surgery program will be two ambulatory clinics which will provide centralized triage, intake, assessment, and post-operative follow-up care. A centralized clinic component such as this, will allow this bariatric program to realize numerous organizational efficiencies and cost savings, and optimize coordination and continuity of care for patients. To this end, Humber River Regional Hospital will expand its current clinic to accommodate a larger volume of patients, and will serve as the model for a new clinic to be established at Toronto Western Hospital. The planning process is already well underway at Toronto Western, and it is anticipated that they will be able to open their doors to bariatric patients by the fall of 2009. A key facet of these two clinics is that they will be able to provide large volumes of patients with highly-coordinated, multi-disciplinary care. Hospital administrators, surgeons, medical specialists, psychiatrists, nurses, dietitians, social workers, occupational therapists and Community Care Access Centres will work collaboratively in an interprofessional practice environment to ensure that patients' co-morbidities are managed properly, their obesity-related conditions and mental health issues are fully addressed, and they are adequately prepared for the lifelong weight management and behavioural modification required for a successful outcome.

Once the program is fully functional, it will serve over 900 patients a year, in the University of Torontoaffiliated hospitals. A total of 17 surgeons will perform bariatric surgery. Distributing the caseload in this manner will prevent any one hospital from being burdened by such a large volume of bariatric patients, and will allow participating surgeons to maintain their current scope of practice.

With the program encompassing six surgical sites, and two clinic locations dispersed across Toronto, efforts to ensure communication throughout the network will be paramount. A nucleus executive committee will be formed with representation from the various sites, not only to facilitate communication, but to provide the multi-site program with effective coordination and management. The Ministry has also created a province-wide bariatric network, which includes an Advisory Board and various working groups, with representation from all provincial Centres of Excellence. This will allow for the sharing of best practice, the development of comprehensive assessment criteria, and the creation of a centralized patient database to generate high-quality evidence-based research.


With respect to research and education, this new surgical program will undoubtedly be able to capitalize on its association with the University of Toronto. Numerous opportunities exist to conduct outcomes and evaluation research, as well as to investigate the efficacy of emerging bariatric technologies. This new program also has very promising academic implications, not only for general surgeons, but for plastic surgeons, anaesthetists, psychiatrists, medical internists, postgraduate medical trainees, nurses, and allied health professionals. Additionally, the new bariatric program should prove to be a natural fit with the University' of Toronto's already established Minimally-Invasive Surgery Fellowship Program.

Most importantly, this initiative will help the province address the ever-increasing waiting list for weight loss surgery, and stem the tide of Ontario patients who undergo gastric bypass surgery outside of Canada. Each patient who has surgery in Ontario, as opposed to the United States, will result in savings of approximately $10,000. With a total of 1660 patients leaving the country for bariatric surgery in 2008/2009, (1) the time for expansion of services in Ontario has arrived. The establishment of the University of Toronto Collaborative Bariatric Surgery Program will do much to curb health care spending, and provide a large patient population with an integrated range of services close to home.

Richard K. Reznick
R. S. McLaughlin Professor and Chair

(1) Ontario improves access to bariatric surgery: McGuinty government moving forward on diabetes strategy. News Release. February 23, 2009

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