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UK report shows safety and effectiveness of surgery
The Second National Bariatric Surgery Report published by the British Obesity & Metabolic Surgery Society (BOMSS) has shown that bariatric surgery in the UK is safe with an observed in-hospital mortality rate after primary surgery of 0.07% and an overall surgical complication rate for primary operations of 2.9%. The report also highlights the effectiveness of surgery; two years after surgery 65.1% of patients with type 2 diabetes returned to a state of no indication of diabetes and were able to stop their diabetic medications, and three years after surgery patients on average lost 59.6% of their excess weight.
The report, published in conjunction with Dendrite Clinical Systems, is the second comprehensive, prospective, nationwide analysis of outcomes from bariatric surgery in the United Kingdom and Ireland, and a result of the data collected by the National Bariatric Surgery Registry (NBSR).
“For all comparisons, the data show that there is great benefit from bariatric surgery for all the diseases studied, in particular the effect on diabetes has important implications for the NHS,” the report states. “By implication, bariatric surgery greatly and cost-effectively improves the health of obese patients, much more so than other treatments.”
The publication has data from 161 surgeons from 137 hospitals who recorded 32,073 operations (18,283 in the three financial years ending 2011, 2012 and 2013). The vast majority (76.2%) of the procedure were funded by the National Health Service and the report includes information on 9,526 gastric bypass procedures, 4,705 gastric band operations and 3,797 sleeve gastrectomy operations.
The reports states that the average BMI was 48.8 and 53.9% of men and 41.4% of women had a high level of co-existing disease (four or more obesity-related diseases); 44.6% of men and 25.9% of women had type 2 diabetes.
“This increase in the burden of comorbid disease is present across all the BMI groups, which means this effect cannot be simply explained away by the assertion that surgeons are selectively treating more and more patients in the super-obese category,” the report continues. “On average, patients presenting for bariatric surgery are becoming sicker.”
The report illustrates the import role bariatric surgery can play in the resolution or alleviation of T2DM. Figure 1 shows that over a three-year post-operative period, patients requiring insulin before surgery were less likely to revert to a non-diabetic state than patients requiring oral hypoglycaemics (p<0.001); this cohort of patients in turn had lower resolution rates than patients treated by diet control alone (p=0.022). It is thought that this is the first data to demonstrate this on the scale of a national real-world registry in over 3,000 patients.
“The aim of bariatric surgery is to improve the overall health of patients by ameliorating, curing or preventing the development of the many diseases associated with obesity,” the reports notes. “In this regard weight loss is not a primary aim of surgery. However, weight loss is a convenient and important proxy measure of the effectiveness of surgery.”
Interestingly, the publication notes that for each type of operation on average men lost less of their excess weight than women. For all three common operations, patients with a BMI of less than 50 lose more excess weight than those with BMIs greater than 50. This might be seen as evidence in support of a policy of operating on patients at an earlier stage in their disease process, states the report.
“Perhaps most importantly, this second report demonstrates the commitment of British surgeons to share their data in the interests of understanding and improving the quality of care they offer,” writes Professor Sir Bruce Keogh, Medical Director of the National Health Service in England, in the Foreword of the report. “The pooling of so much data will help define the place of surgery for people debilitated by obesity and will, in time, help to refine surgical strategies and even unravel the mystery of why this surgery has such an instantaneous, profound and beneficial effect on diabetes, another scourge of our society. In short, this report is a tribute to the professionalism of the British Obesity & Metabolic Surgery Society.”