The Israel National Bariatric Surgery Registry: the inception process

Background: Obesity rates in Israel are increasing, and so is the popularity of bariatric surgeries, which reached in 2017 a prevalence rate of 1428.7 surgeries per million citizens. However, data regarding patient characteristics and surgery outcomes, including complications, are limited and the procedure requires monitoring. Objectives: To establish a national bariatric surgery registry with high reliability and validity. Setting: All private and public medical centers performing bariatric surgeries in the state of Israel. Methods: The Israeli Bariatric Surgery Registry (IBSR) was established in June 2013 by the Israel Center for Disease Control in the Ministry of Health, in collaboration with the Israel Bariatric Surgery Society. An official directive of the Director General of the Ministry of Health as of 2013 made reporting of all bariatric surgeries carried out in Israel mandatory. The bariatric surgery centers relay clinical and surgical information to the IBSR. Presurgery and follow-up outcome information was retrieved from all 4 health maintenance organizations. Results: All 32 certified bariatric units report to the national IBSR. National reporting rates increased from 46.3% in 2013 to 98.7% in 2017. Adherence to bariatric surgery guidelines also increased from 72.8% in 2013 to 98.7% in 2017, and fewer patients not fulfilling the guidelines underwent bariatric surgeries in 2017. Importantly, the considerable annual preregistry increase in surgical procedures has been halted. Registry data regarding obesity-related co-morbidities were validated against hospital files with high Cohen's kappa coefficients for hypertension (r =. 8), diabetes (r =. 8), and sleep apnea (r =. 7). Conclusions: The national IBSR is an identified, validated, mandatory database with access to other national databases, which enables quality assurance of bariatric surgeries in Israel and short- and long-term postoperative follow-up.