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UK bariatric report reveals surgery is safe and effective

Registry shows surgery resolves type 2 diabetes, reduces hypertension and dyslipidemia, and is cost-effective

Bariatric surgery is one of the most clinically effective, safe and cost-effective treatments available to the National Health Service, claim the authors of a new report that reveals the outcomes from the first ever audit of bariatric surgery in the UK.

The “First National Bariatric Surgery Report”, the first publication of data collected by the National Bariatric Surgery Registry (NBSR), shows that severe obesity and its associated conditions could be prevented and eliminated following surgery.

THE NBSR, the result of a unique collaboration between Association of Laparoscopic Surgeons of Great Britain and Ireland, Association of Upper Gastrointestinal Surgery, British Obesity & Metabolic Surgery Society and Dendrite Clinical Systems, collected data from 7,045 operations, out of an estimated 10,000 bariatric operations carried out in the UK 2008 to 2010.

The first report features data from some 86 UK hospitals and includes detailed one-year follow up data from 1,421 procedures, carried out between 1 April 2008 and 31 March 2010.

After two years 85.5% of those with diabetes prior to surgery had no indication of the disease

According to the publication, by the time patients reach surgery approximately two thirds of severely obese patients (BMI 50+) will had three or more associated diseases, with one in ten presented with five or more.

Almost three quarters of patients had limited function (defined as unable to climb three flights of stairs without resting), whilst a third had hypertension, over a quarter had diabetes, nearly a fifth had dyslipidemia and one in six suffered from sleep apnoea. 

Alberic Fiennes

The report states that the observed in-hospital mortality rate after primary surgery is 0.1% overall, with a surgical complication rate of 2.6%. Of patients with a 12 month follow up, the data reveals that, on average, patients lost 57.8% of their excess weight. The authors say these results are comparable with international published results. 

“This data shows that not only is UK bariatric surgery safe but it successfully treats a whole range of diseases, including the rapid resolution of diabetes,” said Dr Alberic Fiennes, a Chairman of the NBSR Data Committee and Past President of the British Obesity & Metabolic Surgery Society.

Follow-up data

From the procedures reporting follow up data, 379 patients had type 2 diabetes before surgery, while one year later that figure had fallen to 188. After two years 85.5% of those with diabetes prior to surgery had no indication of the disease and were able to stop their medications. There was also a reduction in the number of patients who had hypertension, dyslipidemia and sleep apnoea, and fewer patients reported a limited function due to their obesity (Table 1).

Before Surgery 12 months after surgery
Type 2 diabetes 26.8 13.2
Hypertension 31.6 20.4
Dyslipidemia 16.8 8.2
Sleep apnoea 14.6 6.1
Impaired functional status 70.7 36.2

 Table 1: % of patients with co-morbidities before and 12 months after bariatric surgery


The authors also claim that this audit proves that there are cost benefits to the NHS, particularly when considering bariatric surgery for the obese diabetic patient. The report shows that the cost of bariatric surgery is recouped within three years of surgery as obesity associated costs are eliminated.

For example, the costs associated with a bariatric procedure (including hospital stay etc) are approximately £10,000. The costs for treating diabetes alone are estimated to cost £3,000 per patient per year for life. The direct costs of treating obesity-related illness nationwide is £5 billion per year and this is expected to double by 2050.

Current guidelines state that people with a BMI of 40 or more or those with a BMI of 35 plus associated diseases should be considered for surgery.

As a result of the report, surgeons are calling for the Department of Health to invest in a long term strategy to ensure that all patients have equal access to treatment delivered by experienced teams, working out of properly equipped centres that can offer a full specialist assessment and a full range of treatment options. Providers of bariatric surgery must also be able to offer safe long-term follow up, emergency re-admission and commitment to audit.

"An approach that limits treatment to a fraction of those who would benefit is one which the NHS will rue in years to come as these patients become an unsustainable burden on the health service,” said Fiennes. “Prevention strategy alone has proved ineffective; there are at least two generations of morbidly obese patients who are now presenting with diabetes, stroke, heart disease and cancer for whom preventative measures are utterly irrelevant. The numbers are increasing and these people need to be treated.”

John Black

“This audit provides unquestionable evidence that bariatric surgery is cost-effective when the billions of pounds spent in the NHS treating obesity related problems are taken into account. It is a false economy to cut funding for this type of surgery,” said John Black, President of the Royal College of Surgeons. “Any short term savings are tiny compared with the real ongoing cost of treating obese patients. We call upon the Department of Health to promote bariatric surgery. A modest amount of immediate expenditure provides massive returns very quickly, and it makes economic as well as clinical sense.”

However, David Stout, the NHS Confederation Primary Care Trust (PCT) Network Director, said that while surgery was an important part of dealing with increasing obesity and surgeons were right to measure its efficacy, "the most cost effective solution is to make sure that people do not get to the stage of needing surgery in the first place".

He added: "PCTs need to balance their priorities across a wide range of services, taking into account National Institute for Health and Clinical Excellence guidance in the context of local needs. But it is important that all commissioners are transparent in their decision-making."

A spokeswoman for the Department of Health said: “Often, just losing a small amount of weight can reduce the risk of problems such as type 2 diabetes. The local NHS should have weight management services in place to meet the needs of their population. Bariatric surgery should only be considered as a last resort once weight loss schemes and exercise programmes have been tried.”

Professor Sir George Alberti, Chairman of Diabetes UK, said that obesity surgery should be considered in patients who have failed to lose weight through diet and lifestyle changes, and whose diabetes is poorly controlled. “This audit provides evidence that bariatric surgery could be used as a cost-effective method for the NHS to treat obesity-related health problems such as type 2 diabetes. Surgery for severely obese people with type 2 diabetes should be considered much earlier in management rather than held back as a last resort. It should be incorporated into type 2 diabetes treatment protocols.”

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