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Emergency bariatric admissions have significant implications
The National Health Service in the UK will face an increasing number of patients presenting with bariatric emergencies and is unprepared, according to two studies presented at this year’s Annual Scientific Meeting of the British Obesity and Metabolic Surgery Society in Leamington Spa, UK, from 22 – 24 January.
The first study from researchers at Scarborough Hospital, Scarborough, UK, examined the issue of bariatric patients presenting with abdominal emergencies at a district general hospital that does not have an in-house bariatric surgical service.
The investigators retrospectively examined the surgical handover documentation dataset to identify patients who had undergone previous bariatric surgery and were admitted under the care of the general surgical consultant on-call during the period October 2009 to August 2013. Discharge data was then used to establish the patient’s in hospital management.
Between December 2009 and August 2013, there were 54 identified admissions in 38 patients (aged 21-67, mean 44 years, 78% female), who had undergone a previous bariatric procedure either in the UK or mainland Europe.
Thirty five admissions (64%) occurred within the last 20 months of the study period (p=0.0026). Inpatient episodes were managed by consultant surgeons with the following subspecialty interests: colorectal surgery (44), vascular surgery (7), breast surgery (2) and upper gastrointestinal surgery (1). The previous bariatric procedure was a RYGBP (57%), L AGB (24%), LSG (9%), LSG to RYGBP (8%) and intragastric balloon (2%).
The majority of inpatient episodes were managed non-operatively (discharge diagnoses included post-operative pain, constipation, wound infection, abdominal wall cellulitis and cholecystitis), however a significant number of patients required surgical intervention during their admission (adhesive obstruction, incisional hernia, port site hernia, abdominal wall sinus, foreign body in abdominal wall, laparotomy for peritonitis) and two patients required transfer to other hospitals for management of postoperative intra-abdominal sepsis and gastric ischaemia.
“It is increasingly likely that the general surgical on-call service in non-specialist centres will encounter patients who have previously undergone a weight loss surgery procedure,” said study presenter, Dr Tanvir Hossain. “These patients will commonly be managed by consultant surgeons with little or no exposure to bariatric surgical procedures. It is important for the bariatric surgery community to address the provision of emergency care to this patient group in order to provide optimal services for patients and appropriate support for non-specialist colleagues.”
Co-authors of the study were Clare McNaught, Serban Giorgiou, Karl Mainprize, Karen Maude, Marcel Gatt and Robert Macadam.
Private bariatric patients
A second study by researchers from St Georges Healthcare NHS Trust, London, UK, assessed the activity of a 24 hour emergency bariatric surgical on- call service provided by specialist bariatric surgeons with particular emphasis on patient who had undergone previous private (non-NHS) bariatric surgery.
Between November 2011 and November 2013, all patients with an emergency relating to their previous bariatric surgery were referred to a dedicated emergency bariatric surgical service. All patients admitted from clinic, those who were diagnosed with non-bariatric surgical problems were excluded. The remaining patients who presented with a bariatric surgical emergency were recorded and their outcomes analysed.
Over the two year period, 71 patients with bariatric surgical emergency were admitted; 19 had previous surgery in the private sector (16 in the UK, 3 abroad). Of these patients,11 had a previous gastric band, two had an intra-gastric balloon, five had a bypass and one had a VBG.
Of these 19 patients only two were transferred to a private institution. Eleven patients required surgery on the index admission (two patients required two operations) specifically gastric band removal (four), repair of internal hernia (two), diagnostic laparoscopy (two) upper GI endoscopy (one), balloon removal (two) and resection of the alimentary limb (two).
“There is a significant volume of private patients who present as emergencies with complications related to bariatric surgery requiring NHS intervention,” said study presenter, Dr Omar Khan. “These findings have potentially important financial implications for both the private sector and the NHS.”
Co-authors of the study were Rajesh Kumar Jain, Nimalan Sanmugalingam, Marcus Reddy and Andrew Wan.