Value-based health care in bariatric surgery
03 Oct 2017


This is a summary of the pilot study regarding the development of a value-based monitoring platform for bariatric surgery in Sweden.

Initial analysis of data

To understand the relevant outcomes, historical data from 2007 to 2013 on more than 21,000 bariatric surgery procedures was analyzed. The analyses included the preoperative, perioperative and postoperative care, and included data from both the participating county councils’ patient registries and national quality registries. The results were adjusted for patient case mix at the respective care provider and county council to enable comparability.

Value-based health care model

Based on the analysis of the historical cohort and the expert working group the following parameters were included in the VBHC model:

Health outcomes

  • Change in mental health after 2 years
  • Change in physical function after 2 years
  • Percentage change in weight after 2 years
  • Proportion of finished drug treatments in type-2 diabetes after 2 years
  • Proportion free from severe complications within 30 days
  • Proportion without potentially avoidable adverse events in inpatient care, day 31 - 2 years

Resource use

  • Number of health care contacts in the care chain
  • Number of net sick leave days, year 1
  • Time in surgery (in minutes)
  • Inpatient days during surgery
  • Potentially avoidable adverse events related inpatient days within 30 days
  • Potentially avoidable adverse events related inpatient days, day 31 - 2 years

The analyses showed significant differences and variations in treatment methods, health outcomes and resource use between the county councils and clinics for Swedish bariatric surgery.

Recommended actions

Based on the analysis, Sveus’ expert group in bariatric surgery recommended the establishment of a value-based monitoring platform to enable new and important follow-up of bariatric surgery care. In the platform, resource and performance measures can be compared between care providers and county councils.

For more information (in Swedish only):

Sveus is an ongoing research and development project aimed at developing models for value-based health care (VBHC) in several disease areas in Sweden. Seven county councils and regions participate in the work, with support from the Ministry of Social Affairs, including involvement of more than 50 organizations.