Bariatric surgery risks 'not being assessed'
Bariatric surgery is too often being seen as a “quick fix” to solve obesity problems, research suggests.
A new report found that many patients undergo operations without a proper assessment of the risks the procedure poses to them.
More attention should be paid to pre-surgery counselling, the authors said.
The report, conducted by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), examined the care given to 381 patients who were treated both privately and on the NHS.
The authors said that just a third of patients had received psychological counselling prior to referral for surgery, 24% of consent forms did not contain appropriate information and 32% of patients did not receive adequate follow-up after surgery.
And nearly a fifth of patients had to be readmitted to hospital, with some people needing further surgery, the researchers said.
The number of bariatric weight loss procedures - such as a gastric bypass or the fitting of gastric bands or balloons - rose by 70% between 2008 and 2010, the NCEPOD report said.
Between 2008 and 2009 there were 4,200 surgery cases in England, this soared to 7,200 between 2009 and 2010.
“Bariatric surgery is a radical procedure with considerable risks, as well as benefits,” said the report co-author and NCEPOD clinical co-ordinator in surgery Ian Martin.
“It shouldn’t be undertaken without providing full information and support to patients. But, when we reviewed cases we found examples of inadequate processes from start to finish - even the basics, such as giving patients dietary advice and education before decisions to operate are taken, were sometimes lacking.”
Mr Martin also raised concerns about poor consent procedures and lack of psychological counselling prior to treatment, adding: “Consent often happens on the day the patient is admitted for surgery.
“This means there is no time for patients to reflect on their choices and have the opportunity to ask further questions about the risks and benefits of surgery before committing themselves to an operation.”
The report authors said there should be a greater emphasis on psychological assessment before surgery.
They also said there should be a two-stage consent process - so patients have time to weigh up the benefits and the risks.
But separate research published today said that if obese patients undergo bariatric surgery they could quickly reduce risk factors for heart disease and stroke.
The research, published in the journal Heart, said the impact of such surgery is greater and faster than drug treatments for weight management or diabetes and in some cases, could be life-saving.
NCEPOD chair Bertie Leigh said that obesity had reached epidemic levels in the UK costing around £5bn a year, but that surgery could only ever be a part of the solution.
He said: “Surgery is not a panacea, yet both the private sector and the NHS offer a surgical solution to people suffering from an extreme disorder of diet without involving the dietician,” he said, adding: “A clinician treating the problems of a patient needs to understand them at an individual level.”