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NCEPOD report

Surgeons respond to UK surgery report

Surgeons and anaesthetists broadly supported the recommendations made in the report.
Norman Williams: "We will continue to work together with other health professionals in this area to ensure high standards of care and safety are maintained"
Nick Kennedy: "The absence of headline comment on anaesthesia in this report reflects the high quality of practice in this field"

Last week, the National Confidential Enquiry into Patient Outcome and Death released a report, "Too Lean a Service?" which made a number of criticisms and recommendations regarding bariatric surgery provision in the UK. We asked prominent British surgeons and societies about their reaction to the report.

Professor Norman Williams, president, Royal College of Surgeons

“Bariatric surgery is not a quick fix. It has been proven to be an incredibly successful and cost-effective treatment for morbid obesity and the many serious conditions associated with it.

New clinical guidelines aimed at improving the safe and effective provision of weight loss and metabolic surgery in the UK were issued earlier this year by professional bodies who specialise in weight-loss surgery, such as the British Obesity and Metabolic Surgery Society. Recommendations include a rigorous pre-operative multidisciplinary assessment involving surgeons, dieticians and psychologists.

We will continue to work together with other health professionals in this area of surgery to ensure high standards of care and patient safety are maintained.”

Mr Simon Monkhouse, bariatric and metabolic surgery fellow, North Tyneside Hospital

"This report is vital to ensure the future of safe bariatric surgery. It suggests that surgery is occasionally being performed in low volume centres without specialist infrastructure and robust multidisciplinary team input. It was shocking to see that 28% of patients received no documented dietetic input prior to surgery as maladaptive eating behaviours, unless addressed in the pre-operative stage, are likely to continue post-op. This negates the point of surgery as being a tool to help with weight loss.

This report will help the speciality associations to produce standards that all bariatric centres must achieve. Training in bariatric surgery is now more rigorous with the majority of trainees doing fellowships to learn the operative and multi-disciplinary skills necessary to have good outcomes. Most trainees will engage in bariatric education programmes liked SORTED and cadaveric workshops. Hopefully this will translate into sustained, safe practice for many years to come."

Mr Shaw Somers, specialist upper gastrointestinal and bariatric surgeon, The Sudbury Clinic, Harrow and BMI Clementine Churchill Hospital

“I welcome the findings of this report. It should enable clinicians to ensure adequate staffing and resources for the provision of safe treatment in both NHS and private sector provision. The publication of BOMSS service specifications will further strengthen clinicians ability to construct a safe environment for care of this vulnerable group.”

Dr Nick Kennedy, chairman, the Society for Obesity and Bariatric Anaesthesia

"The absence of headline comment on anaesthesia in this report reflects the high quality of practice in this field.

Anaesthesia for morbidly obese patients is fraught with risk, particularly in the hands of the inexperienced or the occasional practitioner. This report is encouraging, showing that bariatric surgery patients are generally anaesthetised by consultants, the levels of monitoring are high, and the complications are low. This suggests that risk can be minimised by good organisation, anticipation of problems and use of experienced staff.

The challenge for the medical community is to ensure widespread awareness of the risks of anaesthetising any morbidly obese patient and to widely implement the safe practices employed by those experienced in this field.

The level of anaesthetist input into preoperative assessment and MDT is of concern. Pre-assessment is particularly important in bariatric surgery. Many patients are very concerned about risk of anaesthesia -anaesthetists are best placed to reassure and assess airway issues. Patients frequently have multiple comorbidities, it is the anaesthetist who provides the peri-operative care - presence at the MDT is therefore obvious.

The report’s comments regarding MDT are reasonable. However, SOBA has concerns that the apparent default position, not requiring pre-admission anaesthetic input for all patients in the non-NHS sector, may compromise quality of patient information, consent and safety, particularly in centres with low volumes or less experience."

Mr Richard Welbourn, council member, British Obesity and Metabolic Surgery Society

“We in the UK specialist British Obesity and Metabolic Surgical Society welcome this report that highlights best practice in looking after bariatric surgery patients.  BOMSS is very keen to push for the highest possible professional standards and has published our own guidelines on our website entitled ‘Providing Bariatric Surgery’.  We recognise that looking after bariatric surgery patients involves a wide range of multidisciplinary care and those who provide this surgery must put all the team members in place so that patients are not left with poor aftercare and are properly supported through their surgical journey.”

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