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Identifying key outcomes

Identifying the key outcomes from bariatric surgery

The top ranked items were ‘diabetes’ for professionals and ‘leakage from bowel joins within the abdomen’ for patients

Healthcare professionals have differing opinions on which outcomes are important following bariatric surgery, according to a study published in the journal, Obesity Surgery. The paper notes that as multi-disciplinary teams (MDT) are involved in care of obese patients it is critical that the views of all relevant health professionals - and patients - are taken into account when evaluating the key outcomes from treatment.

The paper, ‘A Comparison of Health Professionals’ and Patients’ Views of the Importance of Outcomes of Bariatric Surgery’, published on behalf of the By-Band-Sleeve Trial Management Group, investigated and compared how healthcare professionals and patients prioritise outcomes of bariatric surgery.

The researchers developed a 130-item questionnaire (after undertaking a systematic review of clinical outcomes from the literature), which was structured in four sections (complications of surgery; clinical effectiveness; signs, symptoms, and other measures; quality of life). They then asked health professionals (surgeons, nurses, dietitians, psychologists, physicians, and anaesthetists) and patients to rate the importance of each item on a 1–9 scale (1 not important to 9 extremely important). Items rated 8–9 by at least 70 % of the participants were considered prioritised, and items prioritised in each section were compared between professionals and patients and interrater agreement assessed using kappa statistics (ĸ).


The researchers report the items rated 8–9 by 70% of professionals or patients (‘very important’ or prioritised items) in Table 1. The top ranked items were ‘diabetes’ for professionals (89.8% rated 8–9) and ‘leakage from bowel joins within the abdomen’ for patients (86.5 % rated 8–9). Professionals and patients prioritised 18 and 25 items, respectively. There were ten items (out of 130, 7.7%) common to both, which included diabetes and surgical complications such as ‘risk of death within a month of surgery’ and leakage from bowel joins within the abdomen.

Interestingly, 23 (17.7%) items were discordant or prioritised by one group only (eight for professionals, 15 for patients) such as ‘weight’ and ‘re-admission rates’ (professionals only) and ‘feeling able to live a normal life’ and ‘excess skin following weight loss’ (patients only). The kappa statistic of 0.363 indicates a fair level of agreement on the items prioritised between professionals and patients.

Table 2: Items prioritised (rated 8–9 by ≥70 % of participants) by professionals and patientsa

There was moderate agreement (ĸ 0.517) on items prioritised in the complications of surgery section, with nine (out of 42, 21.4 %) items prioritised by both groups and nine (21.4 %) items prioritised by one group only (two by professionals and seven by patients). There was a poor level of agreement (ĸ −0.036) reported for the quality of life and well-being section, and in the clinical effectiveness section only one item (out of 10, 10.0 %) was prioritised by both groups and five (50.0%) prioritised by one group only (four by professionals, one by patients) (ĸ 0.000). In the signs, symptoms, and other measures section, only one item was prioritised by professionals (re-admission rates) and none by patients (ĸ 0.000).

They also found that nurses prioritised the greatest number of items in the questionnaire (33 out of 130, 25.4%). ‘Other professionals’ prioritised the least complications of surgery (11.9 versus 26.2% for nurses) and clinical effectiveness items (40.0 versus 70.0% for nurses) and surgeons the least quality of life and well-being items (2.0 versus 21.6% for nurses). Within the signs, symptoms, and other measures section, all professionals prioritised re-admission rates, except dietitians. Also within this section, ‘vitamin levels’ and ‘mineral levels’ were prioritised by dietitians and nurses only and ‘dysphagia’ by nurses only.

“Our study indicates that different health professionals may have different views of important outcomes of bariatric surgery,” the authors write. “A multi-disciplinary team is typically involved in the care of obese patients; therefore, it is crucial that the views of all relevant health professionals and patients are taken into account when deciding what outcomes are most important to evaluate bariatric surgery.”

This research is part of a wider project that is developing a core outcome set for bariatric surgery (the BARIACT project). It is hoped that a core outcome set will help to standardise the data resulting from future bariatric surgery trials, allowing trial data to be more easily synthesised in meta-analyses, as well ensuring outcomes most important to all relevant stakeholders are used to evaluate bariatric surgery.

The article was edited from the original article, under the Creative Commons license.

To access this paper, please click here

To read more about the BARIACT project, please click here

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