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English bariatric data shows low mortality rate
Surgical data from bariatric surgeons in England has revealed an in-hospital mortality rate of 0.07% (equivalent to survival rate of 99.93%), after three recorded in-hospital deaths from 4,389 procedures. The British Obesity and Metabolic Surgery Society (BOMSS), which welcomes the publication of data on the performance of individual surgeons in several specialities across NHS England, including bariatric surgery, said that in-hospital survival from bariatric surgery is at least as good, if not better, than many common laparoscopic gastrointestinal procedures.
“The publication of surgeon-level data highlights the safety of bariatric surgery and gives patients and other members of the public the opportunity to review the work of individual surgeons,” said Mr Richard Welbourn, Consultant Surgeon, Chair of the NBSR and the President of BOMSS. “We want patients with severe and complex obesity to feel confidence in NHS care and, as surgeons, we want to deliver the best treatment for individuals in the context of team working as well as individual performance."
The online publication of the outcomes follows a December 2012 announcement by the Commissioning Board for NHS England that required publication of surgeon-level outcomes data in ten specialties, including bariatric surgery, by the summer 2013.
UK bariatric surgeon have already embraced the notion of clinical audit when in 2009 three specialist societies (the Association of Laparoscopic Surgeons, the Association of Upper Gastrointestinal Surgeons, and BOMSS) set up the National Bariatric Surgery Registry (NBSR) specifically for this purpose.
In April 2011, the First National Bariatric Surgical Report including over 8,000 patients was published. Since 2009, more than 30,000 patient records have been entered into the registry. An extract from the first NBSR Report can be seen here.
The contribution of data to the NBSR has been voluntary for surgeons up until April 2013, however, the NBSR would have preferred to publish outcomes data from units, since it is units that are commissioned to deliver services to patients, not individual surgeons.
“Bariatric surgery is just one aspect of an MDT process of care that involves a range of healthcare and allied healthcare professionals dedicated to the care of our patients,” added Mr Welbourn. “These include dietitians, specialist nurses, psychologists, bariatric physicians, anaesthetists, theatre teams and recovery staff, ward nurses, outpatient staff, radiographers, radiologists and exercise therapists. The close working and performance of the MDT is integral to the overall outcome.”
Mr Welbourn also called for more administrative assistance to support data validation to help ensure the accuracy of data in the public domain.
The publication of these latest data shows that a total of 105 consultant surgeons contributed to the NBSR and 101 surgeons consented to their data being released (95%). In addition, the data reports that:
- There were no potential statistical outliers for mortality or length of stay;
- The average length of hospital stay for all operations was 2.5 days;
- The average body mass index (BMI) for the patients was 50.6 and the average weight was 141kg, indicating that the patients were twice the ideal weight for their height;
- The majority (72.8%) of patients were female;
- The average number of obesity-related diseases for each patient, for example type 2 diabetes, hypertension and sleep apnoea, was 3.6.
The report does not include revision procedures (to revise a previous bariatric surgical operation).
Using Hospital Episode Statistics (HES) codes it is estimated that there were 138 NHS surgeons performing bariatric surgery in the 11 months April 2012 – February 2013, and 5,656 operations were recorded. Therefore, most bariatric surgeons were entering data and the great majority of NHS patients were being recorded into the NBSR.
“According to HES we estimate that the overall in-hospital mortality rate for bariatric surgery was 0.11% for the four financial years 09/10 to 12/13, equivalent to a survival rate of 99.89%, validating the very low mortality from bariatric surgery recorded by the consultant surgeons contributing to the NBSR,” the BOMSS said in a statement.
The surgeon specific outcomes focus on:
- Consultant workload (total number of operations)
- Operation split by consultant
- In-hospital mortality, described as survival
- BMI on entry into the weight loss programme
- Obesity-Surgery Mortality Risk Score (OS-MRS) and class per operations and overall per consultant
- Initial BMI overall per consultant (box and whiskers)
- Length of stay for primary procedures compared to the rest per consultant
- Co-morbidity count per type of operation (number of co-morbidities recorded per patient, which is taken from the NBSR dataset of co-morbidities: type 2 diabetes, hypertension on treatment, dyslipidaemia atherosclerosis (includes angina, myocardial infarction, CABG, stroke, claudication), sleep apnoea, asthma, functional status (presence of comorbidity defined as unable to climb 3 flights of stairs without resting), back or leg pain from arthritis, GORD, liver disease (suspected NAFLD or worse) poly-cystic ovarian syndrome (female patients only) and depression (clinically significant depression as a reason for bariatric surgery).
“The number of people receiving bariatric surgery has increased dramatically in England - and the developed world generally - in the past decade,” said Mr Peter Small, consultant surgeon, member of the NBSR Committee and BOMSS Council member. “Bariatric surgery is a successful and rapidly developing speciality that helps people regain their health. Collecting information about patient treatment and care using the NBSR will help us further develop the service and improve best practice for our patients.”
With 385 members, BOMSS is the UK professional society of surgeons involved in obesity management. Membership of the society includes medical professionals and allied health professionals including specialist nurses, dietitians and psychologists.