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NBSR outcomes

UK bariatric registry demonstrates surgery improves health of patients

The most commonly performed operation was Roux-en-Y gastric bypass (RYGB; 51.4%), sleeve gastrectomy (SG; 20.2%) and gastric banding (19.7%)
The most common co-morbidities were functional impairment (70%), arthritis (54%), hypertension (37%) and type 2 diabetes (28.7%)
The five-year follow-up period showed statistically significant reductions in the prevalence of T2D, hypertension, dyslipidaemia, sleep apnoea, asthma, functional impairment, arthritis and GERD

Outcomes from the United Kingdom’s National Bariatric Surgery Registry (NBSR) demonstrates that bariatric surgery leads to weight loss and substantial improvements in obesity-related co-morbidities, and as a result patients became healthier and more functional. These are the conclusions from an analysis from over 50,000 bariatric procedures.

The paper, ‘Obesity surgery makes patients healthier and more functional: real world results from the United Kingdom National Bariatric Surgery Registry’, published in SOARD by members of the NBSR Steering Committee, sought to investigate the NBSR and determine whether the effects of bariatric surgery on associated co-morbidities observed in small randomised controlled clinical trials could be replicated in a ‘real life’ setting within UK healthcare system.

The British Obesity and Metabolic Surgery Society (BOMSS) in collaboration with the Association of Laparoscopic Surgeons of Great Britain and Ireland and the Association of Upper Gastrointestinal Surgeons and in partnership with Dendrite Clinical Systems Limited launched the NBSR in January 2009. In 2013, it became mandatory to submit National Health Service (NHS) England data to the NBSR and publish surgeon-level outcomes in 2013. The NBSR software is a bespoke web registry application built by Dendrite Clinical Systems using the company’s Intellect Web proprietary software.

Outcomes

In total, 206 surgeons from 159 hospitals contributed to the current data set and from February 2000 to December 2015, 50,782 procedures were recorded in the NBSR. The most commonly performed operation was Roux-en-Y gastric bypass (RYGB; 51.4%), sleeve gastrectomy (SG; 20.2%) and gastric banding (19.7%). The remaining 8.7% of procedures included duodenal switch, biliopancreatic diversion, revisional gastric band and intragastric balloon or were not specified. Unsurprisingly, the vast majority of procedures were primary surgery (90%) and were performed laparoscopically (93%). The median post-operative length of stay two days from 2007 onward.

The first year after surgery witnessed the most rapid weight loss and reached a nadir of 30±12% total weight loss at two years. This was followed by weight regain and 24±13% total weight loss at five years. The total post-operative complications rate was 3.1%, the most common being vomiting/poor oral intake. The in-hospital mortality rate was 0.07%. Postoperative cardiovascular complications (eg. dysrhythmia or myocardial infarction) were recorded in 0.3% patients.

The majority of patients were predominantly of middle-aged female patients (77.8%) of Caucasian ethnic background (90.4%). The most common co-morbidities were functional impairment (70%), arthritis (54%), hypertension (37%) and type 2 diabetes (28.7%). The authors report that there was a gradual increase in the median number of preoperative co-morbidities over 15 years, with the median number of co-morbidities per patient increasing from one before 2006, to two in 2006 to 2008, and three from 2009 onward.

The authors report that during the five-year follow-up period there were statistically significant reductions were observed in the prevalence of T2D, hypertension, dyslipidaemia, sleep apnoea, asthma, functional impairment, arthritis and gastroesophageal reflux disease. The ‘remission’ of these co-morbidities was witnessed at one year post-operatively and reached a plateau two to five years after surgery.

“Obesity surgery was particularly effective on functional impairment and T2D, with almost a doubling of the proportion of patients able to climb three flights of stairs, compared with preoperatively, and a halving of the proportion of patients with T2D-related hyperglycaemia, compared with preoperatively,” the authors write. “The only recorded co-morbidity for which no significant change was recorded was PCOS and/or infertility.

The authors note that the NBSR has already changed healthcare policy in the UK with the National Institute of Healthcare Excellence (NICE) extending the definition of recent-onset T2D to include patients with disease duration of ten years and a BMI30-35. In addition, more RCTs were thus able to be included in the NICE analyses, leading to lowering of the BMI eligibility criteria for surgery to 30.

The authors acknowledge that a key limitation of the NBSR is sparse record of follow-up after two post-operative years. They note that there is currently no mechanism to capture data from primary care in the registry, compared with cancer treatment and survival.

“The NBSR data demonstrate on a large scale that obesity surgery leads to weight loss and substantial improvements in obesity-related co-morbidities. Patients become healthier and more functional,” the paper concludes. “Surgery is safe despite the patients having more obesity-related disease over time. Appropriate support and funding will help improve the quality of the NBSR data set even further, thus potentially increasing its effect on healthcare policy.”

To access this paper, please click here

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