1. Sid 1 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Work absenteeism and Gastric bypass: A six-year study Jönsson E 1, Ornstein P 1,2, Goine H 1,3, Hedenbro JL 4 1 Swedish Social Insurance Agency 2 Department of Statistics, Uppsala University 3 Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University 4 Department of Surgery, Clinical Sciences, Lund University

2. Sid 2 Juni 2016 Work absenteeism and Gastric bypass: A six-year study None of the authors has any conflicting interests.

3. Sid 3 Juni 2016 Work absenteeism and Gastric bypass: A six-year study The beneficial effects of gastric bypass surgery are well documented: – Quality of life – Resolution of comorbidities – Mortality We studied the indirect costs of work absenteeism through social insurance benefits before and after gastric bypass surgery. Background and aim of study

4. Sid 4 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Data (cross matched) – Scandinavian Obesity Surgery Registry (SOReg); (national coverage > 98%). – Data from the Social insurance Agency (coverage 100%). All patients operated in Sweden during 2010. Patients and methods

5. Sid 5 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Patient population Total operated N=7454 Total operated N=7454 Excluded, insurance reasons - On disability pension, n=776 - Age 62, n=256 - Income < 10 750 euro, n=1332 Excluded, insurance reasons - On disability pension, n=776 - Age 62, n=256 - Income < 10 750 euro, n=1332 Included operated n=4971 BMI 42.6; 75 % female Included operated n=4971 BMI 42.6; 75 % female Excluded, medical reasons - Not RYGB, n=198 - Incomplete T2D FU, n=61 Excluded, medical reasons - Not RYGB, n=198 - Incomplete T2D FU, n=61

6. Sid 6 Juni 2016 Work absenteeism and Gastric bypass: A six-year study The reference population was created from the Swedish Social Insurance Agency database Age-, sex and income matched. Based on individuals living in Sweden during 2010 without disability pension and with employment defined as a declared income of >10 750 Euros. Reference population

7. Sid 7 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Day 1: Not reimbursed. Day 2-7: Reimbursed by employer. No medical certificate needed. Day 8-14: Reimbursed by employer. Medical certificate needed. Day 15 - : Reimbursed by national social insurance agency. Medical certificate needed. Sickness insurance system in Sweden

8. Sid 8 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Results

9. Sid 9 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Obese patients had a higher absenteeism throughout the study period Obese patients had a spike in absenteeism around the time of the operation. Number of net reimbursed absenteeism days per three months period; -3 to +3 years from operation; separated for gender and group.

10. Sid 10 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Both the patient cohort and the reference population displayed similar patterns of absenteeism over the six years studied Long-term relative differences between patients and the reference population were thus consistent with preoperative differences. Relative change of net absenteeism in relation to the corresponding quarter in year -3.

11. Sid 11 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Patients with preoperative comorbidity had more sick-days than those without, both pre- and postoperatively. There were no obvious quantitative or qualitative differences between diabetics and those with other comorbidity. Number of net absenteeism days per 3 months period by pre-op health status; - 3 to +3 years from operation;.

12. Sid 12 Juni 2016 Work absenteeism and Gastric bypass: A six-year study No differences in absenteeism between preoperative diabetics with- and those without 1- year postoperative diabetes resolution Number of absenteeism days per 3 months period, only diabetics; by post-op diabetes resolution

13. Sid 13 Juni 2016 Work absenteeism and Gastric bypass: A six-year study Post-operative complications did not outweigh potential health benefits, i.e. RYGB did not lead to any major changes in work absenteeism. After surgery, patients with diabetes resolution did not deviate towards normal values but remained in parallel to diabetic patients without resolution. Conclusion

14. Sid 14 Juni 2016 Work absenteeism and Gastric bypass: A six-year study The medical and Quality of Life benefits from bariatric surgery can be obtained without increasing societal costs in terms of absenteeism. Absenteeism pattern of preoperatively diabetic patients seems to be governed by factors other than diabetes resolution. In summary