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Third UK bariatric report shows safety and effectiveness of surgery

Thu, 10/08/2020 - 15:55
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The British Obesity and Metabolic Surgery Society (BOMSS) and dendrite Clinical Systems have published the Third National Bariatric Surgery Registry (NBSR) Report that outlines the safety and effectiveness of bariatric and metabolic surgery. This latest report examines data from 19,104 Roux-en-Y gastric bypass (RYGB) procedures, 13,841 sleeve gastrectomy (SG), 4,499 gastric bands (GB) and 1,515 One Anastomosis Gastric Bypasses (OAGB) performed between 2013 and 2018. Mirroring global trends, SG replaced RYGB to become the commonest bariatric procedure in the UK in 2018. The report uses data from the National Bariatric Surgery Registry (NBSR), a decade long research collaboration between BOMSS and Dendrite Clinical Systems - a specialist developer of national and international registries, and clinical software solutions.

The outcomes demonstrated that in-hospital mortality was 0.04%, which compares very favourably with internationally accepted figures. The effectiveness of surgery showed that the prevalence of Type 2 diabetes mellitus was reduced from 30% to 14% in the first year after surgery (Figure 1). Moreover, excess weight loss at one year of 73.7% after OAGB and 71.3% after RYGB compares favourably against 61.5% with SG and 38.8% with GB.

Figure 1: Primary surgery for adults: Type 2 diabetes rates pre-operatively and one year post-operatively; operations in financial years 2013-2018
Figure 1: Primary surgery for adults: Type 2 diabetes rates pre-operatively and one year post-operatively; operations in financial years 2013-2018
 

David Kerrigan
David Kerrigan
 

 

"The NBSR is an example of what we can achieve collectively for the benefit of our patients. This third report once again highlights the exceptional safety and efficacy of bariatric surgery in the United Kingdom (UK),” said David Kerrigan, President of BOMSS. “There are many firsts in this report that deserve a special mention. For the first time, we have attempted to analyse data for each United Kingdom nation separately, and for England, we have broken it down by region. I am sure local commissioners and clinicians will find this extremely useful. When it comes to surgical procedures, for the first time, the report contains data on a large number of One Anastomosis Gastric Bypass procedures and a whole section on Revisional Surgery, which is undoubtedly becoming more common globally. The comparisons between different revisional procedures are particularly interesting.”

The report reveals that the number of procedures reported from North Ireland, Scotland, and Wales are disproportionately low emphasising the need to build NHS capacity in these regions and encourage use of the NBSR to record activity. Analysis of regions in England also demonstrates significant variation in NHS funding as well as the nature of procedures.

The total number of primary procedures performed (both public and private sector) has stayed relatively constant at around 6,000-7,000 per year over the past decade with National Health Service (NHS) funded procedures accounting for approximately threequarters of all recorded activity.

Additional key findings from the report include:

  • Males seek bariatric surgery later in the course of their disease and they generally have a higher BMI (average 47.1 kg m2 vs 45.9 kg m2) than female patients and more obesity-related disease than female patients.
  • The overall complication rate was approximately 2.4%.
  • It is not known whether the reported higher in-hospital mortality of 0.13% seen with OAGB compared to 0.05% seen with RYGB and 0.04% with SG is down to a learning-curve effect or due to patient selection.
  • The overall length-of-stay of patients underwent primary bariatric surgery remains low. Over 90% of patients stayed one day or less in hospital after a gastric band procedure, for RYGB, sleeve gastrectomy and OAGB/MGB patients, over 70% were discharged by the second day after surgery. There has been a decrease in the average length-of-stay since 2007 (from just over four days to under three days).
  • There was a significant improvement in functional status with those who could not climb 3 flights of stairs without resting reduced from over 65% to just over 25% one year after bariatric surgery.
  • There was also considerable reduction of hypertension in all four groups of bariatric surgery patients one-year post-operation, with the overall prevalence of hypertension dropping from approximately 37% to 23%.

“The registry is a remarkable achievement ensuring that surgeons are sharing their outcomes with each other and their patients. Only by doing this in an open and honest way will the highest standards of technical and peri-operative care be maintained,” said Neil Mortensen, President of the Royal College of Surgeons of England. “In order to make a case for the wider availability of bariatric surgery, registry data like these will be invaluable. As we begin to restore planned surgical services after the first wave of the pandemic there will be many calls on operating room availability. This report will allow the British Obesity and Metabolic Society to make a strong argument for surgery as a solution to obesity, not only as a risk factor for Covid 19, but its many other well recognised sequelae.”

To view or download the report, please click here