NEBSA to audit bariatric surgical emergencies in the UK

Researchers from the UK have designed a prospective, multi-centre, audit of bariatric surgical emergency (BSE) activity in all UK hospitals - the National Emergency Bariatric Surgical Audit (NEBSA). Eligible participants are those who undergo any intervention or procedure (surgical or endoscopic) to diagnose or treat BSE.

The researchers explained that significant challenges impede tracking the incidence and nature of severe complications in the context of bariatric surgery. As the prevalence of bariatric procedures escalates, the establishment of a dedicated, prospective complication registry becomes imperative. This study is designed to capture and assess the ramifications of emergency bariatric surgical practices within the United Kingdom.

“Such an initiative would facilitate a nuanced understanding of BSE within the current healthcare milieu, enhance economic evaluations, elucidate long-term patient outcomes, and inform requisite adjustments in professional training,” they stated.

The primary outcome measures will include hospital length of stay, rates of complications (Clavien–Dindo) and 30-day mortality. Secondary outcomes will assess the broader impacts and patterns of care, including variations in practice and resource utilisation across the UK, rates of outpatient follow-up and the frequency of subsequent procedures (surgical or endoscopic) post-BSE. Additionally, the study will investigate potential predictors for patients’ choice between state-funded and self-pay bariatric surgery options, considering factors such as ethnicity and previous engagement with NHS-specialized weight loss pathways.

This study will be registered as clinical audit at each participating hospital and the protocol will be disseminated through the British Obesity and Metabolic Surgery Society network and using a targeted social media-based strategy in the UK. Data will be collected online via a bespoke data collection tool.

The researchers noted that there is a recognised knowledge gap concerning the patterns of presentation and impact of complications following bariatric surgery – with a discrepancy between the overall complication rate recorded in the Hospital Episode Statistics register and that reported to the NBSR, identified as 2.38%. This disparity may stem from participants presenting to alternate hospitals other than the index hospital where their surgery was performed, and efforts are being made to rectify these discrepancies. Moreover, some bariatric centres and most non-bariatric hospitals may not subscribe to NBSR, further widening this knowledge gap. This presents an opportunity for an all-inclusive database to include all centres admitting and treating patients with complications following bariatric surgery.

Setting

All hospitals in the UK offering emergency gastrointestinal surgery and bariatric centres will be invited to participate. Participants will be identified over a six-month period Provisionally, the initial study period started in October 2024 to April 2025. However, other hospitals have registered later than the planned start date, and data collection is still ongoing for a separate six-month cycle. At the time of submitting the protocol manuscript (December 2024), some centres are still contributing to the first round of data collection. A second period of data collection is scheduled from June to December 2025.

Inclusion criteria

• Admissions from i) the emergency department, clinic, urgent care, or primary care to the bariatric surgical team as an emergency; ii) from an inpatient team as an urgent referral; iii) a return to theatre following an elective bariatric procedure; and iv) another hospital via patient transfer to a specialised unit.

• Participants undergoing any intervention or procedure to treat or diagnose bariatric complications, (e.g. OGDs, interventional radiology, surgery, and supplemental enteral or parenteral nutrition).

  
  

Exclusion criteria

• Age <18 years old

• Have a length of stay <24 hrs

• Initial diagnosis of BSE is changed or if their readmission is found to be unrelated to previous bariatric surgery.

• Data storage, protection, and validation

“NEBSA represents a significant step forward in our understanding of emergency bariatric surgical practices in the UK. By providing a detailed analysis of current practices, patient outcomes, and various factors influencing these outcomes, this study holds the promise of informing and improving clinical practice and policy-making in the field of bariatric surgery,” the researchers concluded. “Being mindful of its limitations, NEBSA’s contributions to the field are expected to be substantial, offering a foundation for future research and a guide for ongoing improvements in patient care.”

The study protocols were described in the paper, ‘National Emergency Bariatric Surgical Audit (NEBSA): a protocol for a multi-center prospective study of unplanned interventions following emergency bariatric surgery’, published in the International Journal of Surgery Protocols.

To access this paper, please click here