Patients who have had bariatric surgery may not be receiving follow up care from their GPs as recommended in clinical guidelines, according to researchers from the University of East Anglia (UEA) and the University of Birmingham. Although clinical guidelines recommend that patients receive nutritional and weight monitoring annually for life following surgery, this study reported that this does not appear to be happening in most cases, leading to weight regain and malnutrition
The study, ‘Post-bariatric surgery nutritional follow-up in primary care: a population-based cohort study’, published in the British Journal of General Practice, was funded by the National Institute for Health Research (NIHR) Clinical Research Network West Midlands. The authors believe it is the first study to investigate whether patients receive sufficient long-term routine care and monitoring in primary care following weight loss surgery in the UK.
"Patients are supported to make changes to their eating before surgery and these changes need to continue after surgery to help avoid putting weight back on and to keep well. In addition, it is important that patients take lifelong nutritional supplements after their surgery,” said lead researcher, Dr Helen Parretti, from UEA's Norwich Medical School. "But patients need support to achieve this after their operations and current guidance recommends this is offered by GPs. Without this, weight loss surgery has long-term risks such as nutritional deficiencies and weight regain can occur.”
For the study, the investigators examined data from primary care practices contributing to IQVIA Medical Research Data and included adult patients who had bariatric surgery with a minimum of three years’ follow-up post-surgery. Outcomes were annual proportion of patients from 2yrs post-surgery with a record of recommended nutritional screening blood tests, weight measurement and prescription of nutritional supplements, and proportions with nutritional deficiencies based on blood tests.
"There is international clinical consensus that long-term follow-up care following bariatric surgery is important to optimise patient outcomes and reduce the risk of preventable harms. We wanted to find out whether the nutritional care and weight monitoring delivered by GPs following bariatric surgery meets current clinical guidance."
Types of surgery included gastric bands, gastric bypass and sleeve gastrectomy. In total, 3,137 participants were included (between 2000 and 2015) and median follow-up post-surgery was 5.7 (4.2-7.6) years with 45-59% reporting an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, e.g. recorded haemoglobin measurement varied between 44.9% (n=629/1400) and 61.2% (n=653/1067).
Annual proportions of blood tests specific to bariatric surgery were low, e.g. recorded copper measurement varied between 1.2% (n=10/818) and 1.5% (n=16/1067) (where recommended). The most common deficiency was anaemia and the annual proportions of patients with prescriptions for recommended nutritional supplements were low.
"We found that in most cases, patients were not receiving the recommended long-term monitoring after they are discharged from bariatric services. We found that only around half of the participants were having their weight measured annually. In addition, only around half were having blood tests for nutritional deficiencies commonly seen in general practice, such as anaemia. The percentage of participants having blood tests more specific to bariatric surgery was very low, around five percent or less each year. The most common deficiency we found was anaemia - around 40-50 per cent of those patients who had had a blood test. This shows that there is an urgent need to support GPs and patients to engage with post-bariatric surgery nutritional reviews and monitoring, for example through education and commissioning of services to provide this long-term care."
The study concluded that GPs and patients should be supported to engage with follow-up care and future research should aim to understand the reasons underpinning these findings.