Researchers from the University Hospital Galway, Wexford General Hospital, Royal College of Surgeons in Ireland and Ninawa School of Medicine, Iraq, have called for the creation of a register of patients who have bariatric procedures abroad to ensure appropriate post-operative care and facilitate dealing with post-operative complications if they arise.
Writing in the paper, Challenges associated with Global Bariatric Medical Tourism, published in this month’s Irish Medical Journal, the researcher noted that: “The limited access to timely bariatric service in Ireland has led to significant waiting times. Cheaper weight loss procedures in certain parts of the world have incentivised patients to seek bariatric surgery abroad. There are multiple challenges associated with global bariatric tourism. Patients do not have access to adequate information regarding the bariatric procedure and they resort to informal blogs to access this information resulting in patients to underestimate the risks associated with bariatric surgery and believe that their surgeries will be complication-free.”
The study examined four bariatric cases and found that all patients underwent “surgical intervention including reversal of the index bariatric procedure” when they returned to Ireland after surgery abroad. To date eight people are officially known to have died abroad while undergoing cosmetic surgery abroad - of those figures, several were during or soon after bariatric surgery.
The total cost to Ireland’s Health Service Executive (HSE), which provides public health and social care services to everyone living in Ireland, for managing and treating the complications from these four bariatric cases carried out abroad was €48,220.
“Global bariatric procedures can carry a significant risk of complications if appropriate post- operative care is not accessible. Managing these complications have been a huge burden on an already under-resourced healthcare system. This requires stricter regulations with appropriate patient education and follow-up, they explained. “Having a registry of patients who have bariatric procedures elsewhere will ensure appropriate care post-operatively and facilitate dealing with post- operative complications if they arise.”
The co-authors as a result of their findings have also called for the “name of the performing surgeon and their contact number, dates of expected follow-up, emergency plans, and most importantly data regarding the details of the weight-loss equipment used as this would potentially improve patient outcomes when dealing with complications” to form part of a national register.
“Importantly, it will also aid in estimating the annual cost of bariatric medical tourism to the HSE, the co-authors wrote.
Currently, bariatric procedures are only offered in two public hospitals in Dublin and Galway. The high demand for such procedures has led to long waiting times as evidenced by figures published by the Health Service Executive (HSE) where only 154 bariatric procedures were performed in 2020, a drop from 169 from the previous year, amounting to €1.3 million to the HSE. It is estimated that a total of €5.7 million was spent on bariatric procedures over the last five years with one of the biggest barriers to offering greater numbers of bariatric surgery being the availability of adequate funding.
The annual cost to the healthcare system of Irish adult obesity is estimated to be €1.3bn of which €400m is attributed directly to healthcare cost. Non-operative management options such as lifestyle modification and weight-lowering drugs.
In order to avoid this, the HSE has a Treatment Abroad Scheme (TAS) where consultants can refer patients for procedures in the European Union, European Economic area or Switzerland if the procedure is not available in Ireland or cannot be accessed within a timely fashion.
The referrals will have more credibility as the consultants will have to research the accreditation, qualifications, morbidity and mortality data before referring patients. However, whether surgeons will have the time to accommodate this extra work remains to be seen.