The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has published results of a survey of its members highlighting bariatric medical tourism (BMT) trends worldwide and areas of concern in the care of such patients. They have suggested guidelines for BMT which featured in the paper, ‘A Global Survey by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) on Perceptions of Bariatric Medical Tourism (BMT) by Health Professionals: Guidelines from IFSO for BMT’, published in Obesity Surgery.
The paper recommended:
- The creation of an International Bariatric Medical Tourism Forum
- Surgeons should apply strict adherence to IFSO and ASMBS guidelines when offering Bariatric Metabolic Surgery (BMS)
- Appropriate pre-operative education, workup and consenting
- Informative discharge summary containing the technical details of the BMS performed as well as the postoperative directions made to the patient in appropriate language
- Better coordination between countries
- Hospitals to register with International Healthcare Accreditation (IHA) and more visible lists to be available on internet or on IFSO website; and
- Create an International Medical Bariatric Tourism Registry that would help monitoring, surveillance and gather long-term results and data.
The researchers carried out a global survey consisting of 41 questions on behalf of IFSO to assess the details of BMT and the perceptions of bariatric health care professionals (HCP) regarding BMT. In total, 383 bariatric health professionals responded to the survey, the vast majority were bariatric surgeons (92%, n=350) with cumulative experience of 272,548 bariatric surgeries. Over 60 country were represented and the top five respondents by country were Brazil (7.7%), Mexico (7.1%), United Kingdom (UK) (6.6%), USA (5.3%) and Turkey (5.0%). The majority worked in the private sector (44.9%, n=171), 24.7% (n=94) were in government practice, 25.7% worked in both and the remainder working for companies.
A majority (73.2%, n=277) of respondents had managed patients undergoing BMS in a foreign country, with 35.5% performing such operations, 9.7% dealing with complications when a patient returned to their home country and the remainder dealing with both. Most (55.5%) managed one to five patients per month, with 12.1% seeing six to ten per month and 4.4% seeing over 50 patients undergoing bariatric surgery abroad per month. The vast majority of patients (73.0%) were aged between 26 and 40 years and were female (77.5%).
The top five countries from where the patients travelled for BMT were from USA (11.6%), Germany (6.3%), UK (5.0%), Saudi Arabia (4.8%) and Canada (4.3%). Patients from the UK were most likely to travel to either Turkey or eastern European countries, Americans were most likely to travel to Mexico (32.9%) or other countries in Latin America (37.1%). Patients from Saudi Arabia most frequently underwent surgery in eastern European countries (36.7%) or Egypt (26.7%) and Belgians were most likely to visit the UK (42.9%) or the Netherlands (23.8%). Turkey was the main destination for German patients (43.6%), follow-ed by eastern European countries (30.8%).
Fifty-one percent of respondents believed patients would travel to save between 25 and 50% of the total surgical cost. In terms of the popularity of BMT, 48.2% of respondents thought it was in the top five fields of health tourism, with 45.5% believing it to be in the top 3.
A majority of 71.2% of clinicians were contacted through word of mouth (patient recommendation), 50.0% vis online advertising, 40% colleague referrals and 23.4% through medical tourism companies. Interestingly, 44.7% of respondents felt the patients received inadequate pre-surgical education, whilst 18.3% replied that the patients received no preoperative education and work-up. Worryingly, only 35% of patients were discussed in multi-disciplinary team (MDT).
Regarding BMI, 51.2% said a BMI 60kg/m2 should be the upper cut off limit for bariatric surgery as BMT, with 33.4% stating that there should be no upper limit, 43.2% said patients with ASA ≤ 2 should undergo surgery, with 41.0% of the opinion that ≤ 3 was acceptable and 13.3% responded that there should be no restriction. Nearly a third of responders (30.4%) said that the consenting was not appropriate and patients were not provided with translators in case of language mismatch, with a similar number (33.2%) believed there should be strict policies governing BMT and 2.4% stating that it should be banned completely. Nearly 85% supported the idea of having an International Bariatric Surgery Medical Tourism Forum.
The survey also reported:
- Israel was the most expensive country for bariatric surgery, with an average cost of US$20,000,
- Egypt was a cheapest costs for bariatric procedures (US$3000), followed by Russia (US$3700) and Ukraine (US$3900)
- 34.9% felt that BMT would give patients poor overall results
- 15.6% of the total respondents felt that international guidelines for patients meeting eligibility criteria for bariatric surgery were not followed
- In total, 13.6% of respondents felt that patients should be accountable for complications if they occurred (42.9% of respondents from Mexico felt patients should be accountable for their complications and 25% from Argentina)
“Better malpractice regulations in the destination country and better communication (e.g., discharge summaries) and collaboration between two countries would improve patient safety and outcomes,” the authors concluded. “…This is the first reported survey by IFSO on BMT. This highlights the need for Registry and Research for better understanding of that with the ultimate goal of better and safe patient outcomes.”