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New UK bariatric surgery guidelines published
The British Obesity and Metabolic Surgery Society (BOMSS) and the Independent Healthcare Advisory Services (IHAS) have released guideline documents intended to improve safe and effective provision of weight loss and metabolic surgery in the UK.
BOMSS’ document, “Providing Bariatric Surgery - BOMSS Standards for Clinical Services and Guidance on Commissioning”, seeks to codify the best of existing national and international guidelines, and translate them into practical service and quality structures for the UK.
“Weight loss and metabolic surgery is already carried out to an extremely high standard in the UK, but some complications are inevitable in any surgery - perhaps especially in higher risk groups of patients,” said Mr Alberic Fiennes, president of BOMSS. “We are working together to ensure the highest standards of care for bariatric patients.”
BOMSS’ guideline document emphasises that bariatric surgery should be safe, based on recognised best practices, effective and cost-effective.
Surgery should be delivered by a specialist multidisciplinary team, consisting of specialist bariatric surgeons, bariatric nurse specialists, and specialist bariatric dietitians. Access to other specialists, including physicians, psychologists and anaesthetists, should be immediately available.
All personnel, facilities and equipment should meet BOMSS professional standards, and patients must have access to appropriate levels of recovery and critical care support.
Follow-up should be provided to ensure the effective diagnosis and treatment of post-operative and delayed complications, as well as checking on clinical outcomes, nutrition, and patient needs. The document describes the lack of any follow-up as “deplorable”.
The document also states its commitment to national audit through its National Bariatric Surgery Registry.
IHAS - the representative trade body for most independent UK healthcare providers – wrote their document, “Clinical Guidelines for the Establishment of a Bariatric Surgical Service” – with the help of BOMSS, the Society for Bariatric and Obesity Anaesthesia, and other healthcare organisations.
IHAS say that their guidelines reflect a consensus reached after extensive debate between bariatric surgeons and anaesthetists. The document is intended to help hospital directors or medical advisory committees design a new bariatric service or benchmark an existing one.
Like the BOMSS document, the IHAS guidelines emphasise the importance of the multi-disciplinary team, requiring ready access to a psychologist or psychiatrist with experience in eating disorders and behavioural change, a sleep apnoea assessment service, and a diabetologist.
IHAS recommends that patients should be risk-assessed, recommending the Obesity Surgery Mortality Risk Score and the American Association of Anaesthetists’ physical status classification score. It should be a rigiorous multidisciplinary process, involving surgeons, anesthetists, dietitians, specialist nurses, and psychologists wtih specialist experience in the field.
The document mandates that level 2 critical care must be available to all units undertaking bariatric surgery.
It also outlines standards for open and laparoscopic bariatric training, including course attendance, sufficient caseload, and membership of a professional bariatric surgery society.
Professor David Kerrigan, a leading bariatric surgeon who advised the government on the current UK National Institute for Clinical Excellence obesity guidelines, said: “I’m delighted to help set clear and unambiguous guidance to help hospitals and patients identify the key components of a well-run bariatric service performed by properly trained doctors.”