Authors' objectives: Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a UK setting. Our aim was to establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life (QoL) and the effect on comorbidities. In this observational cohort study, we established the physical and mental health, and social burden of severe obesity; the incidence of acute and chronic postoperative (postop) complications of bariatric surgery; the effect of the pre- and postop care pathway on complication rates and weight loss, for different bariatric surgical procedures; change in QoL, anxiety and depression, weight status, over time pre- and postoperatively for a mean of 3 years from date of bariatric surgery; the glycaemic control, lipids, blood pressure, medication prescription and rate of diabetes complications (microalbuminuria and renal disease, and retinopathy) in those who have pre-existing diabetes; and changes in socioeconomic factors (employment, benefit receipt, sick leave and healthcare use) for 3 years since bariatric surgery.

Authors' results and conclusions: Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was −19.0% (±14.1) from the operation and −24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (

Authors' methods: Prospective observational cohort study. National Health Service secondary care and private practice in Scotland, United Kingdom. Adults (age >16 years) undergoing their first bariatric surgery procedure. Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. We conducted a prospective observational cohort study in National Health Service (NHS) secondary care and private practice in Scotland, UK. The study recruited participants from 10 NHS Hospitals and 4 private hospitals that were performing bariatric surgery. Adults (aged 16 and over) scheduled to undergo a primary bariatric surgery procedure were eligible for invitation to the study and were identified by their bariatric surgery clinical team. The only other inclusion criterion was residence in Scotland as that allowed study follow-up through electronic health records; those who had previous weight-loss surgery or were undergoing a repeat procedure were excluded from the study. Participants were asked for consent for health record data linkage (part one), postal and/or electronic follow-up (part two) and whether they were interested in future research. Those requiring a translator were asked for consent for clinical data linkage only. Recruitment was stopped and follow-up reduced from 10 to 3 years due to low numbers of bariatric surgery procedures in Scotland making recruitment of the intended 2000 participants impossible. Completion of baseline and year-3 questionnaires by participants was much lower than anticipated, leading to a high proportion of missing data.

Authors' identified further research: Future research should consider the selection and pathways of care for people undergoing bariatric surgery. There should be consideration of a balance of outcomes and clarity around which non-surgical interventions, if any, should be considered prior to surgery for which groups. Randomised trials of pre- and post-surgery multidisciplinary interventions are required to ascertain the optimal care pathway to support safe and effective surgery. Standardisation of outcomes in bariatric surgery is key within future research to allow comparisons and meta-analysis, as is research to improve participant response rates to patient-reported outcome measures within efficient study designs.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/10/42/02

Year Published: 2024

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/UNAW6331

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/UNAW6331

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk