Last month, the UK National Enquiry into Patient Outcome and Death (NCEPOD) released a report (Bariatric Surgery: Too Lean a Service) on the process of care for patients aged over 16, who underwent bariatric surgery for weight loss in the UK and found that significant improvements are needed across the whole of the care pathway, with more emphasis on specialist support before and after surgery.
The report is based on findings from in-depth case reviews of 381 patients who had bariatric surgery with the UK National Health System (n=223) or in private hospitals (n=173) in England, Wales, Northern Ireland, the Isle of Man, Guernsey, and Jersey.
The report highlights a number of important deficiencies in the care of these patients including, lack of assessments and consultations by dietitians or psychologists both before and after surgery, significant delays in follow-up, surgery on patients who did not meet guidance criteria, high readmission rates, inadequate consent forms and procedures, low surgical volumes, and lack of follow-up.
It also found that two out of three websites of programs failed to give a clear explanation of the risks involved and of the chances of achieving weight loss.
The report lists a number of proposals to improve bariatric surgery including ensuring that all patients have access to the full range of appropriate specialist professionals, a deferred two-stage consent process, and postoperative dietary guidance.
It also clearly recommends that all decisions on whether or not a patient is suitable/ready for weight loss surgery should be made with the input of a number of different health care professionals.
Although standards may well vary between countries, I have no doubt that careful review of the quality of pre-, peri-, and post-surgical care of bariatric surgery patients will probably leave much to be desired in most countries, including perhaps in Canada.
The report certainly makes clear that neither the decision to undergo surgery nor the processes and standards to ensure acceptable outcomes are to be taken lightly.
Bariatric surgery (even in its most minimally invasive form) remains a serious and complex intervention for a serious and complex problem – any health professional suggesting anything else, is guilty of nothing less than professional misconduct.