Endocrine Abstracts

Background: Whilst bariatric surgery is cost effective in the management of severe or complex obesity, successful outcomes necessitate specialist multidisciplinary pre-operative and post-operative care. The report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), Too Lean a Service? A review of the care of patients who underwent bariatric surgery (2012) made critical recommendations for the process of care.

Aims: To assess the delivery of pre-operative and post-operative care for patients undergoing bariatric surgery in a single centre.

Setting: Specialist weight management service in a university teaching hospital.

Methods: We performed a retrospective observational analysis of the elements of pre-operative and postoperative care for patients who underwent bariatric surgery during a two-year period between 31^st July 2010 and 31^st July 2012.

Results: A total of 334 patients had bariatric surgery which included 231 (69%) gastric bypass, 86 (26%) sleeve gastrectomy, 13 (4%) gastric banding and 4 other procedures.

Pre-operatively, 98% had documented evidence of multidisciplinary team review at a one stop clinic that comprises bariatric specialist nurse, bariatric dietitian, bariatric physicians and bariatric surgeons. All patients underwent sleep studies for obesity-induced hypoventilation and obstructive sleep apnoea and 84% had documented pre-bariatric psychological assessment and counselling. All the patients had preoperative evaluation involving clinic review and blood tests, electrocardiogram, pulmonary function tests and anaesthetic assessment if required.

Postoperatively, 97% of patients had documented multidisciplinary ward rounds comprising bariatric surgeon, bariatric physician, specialist nurse and specialist dietician prior to discharge. During the first week after discharge patients received phone calls from the bariatric specialist nurse (95%) and specialist dietician (54%); 97% of patients were reviewed in a specialist nurse-led outpatient clinic at median 7 weeks after surgery. Further dietetic review was offered to 81% of patients and 68% attended. Specialist medical annual review was arranged for 97% of patients, of which 45% attended during the study period.

Conclusions: We report near universal levels of documented evidence of concordance with multidisciplinary elements of pre-operative care. Attendance for standardised long-term post-operative medical care should be improved but challenges include a wide geographical catchment area and the need to take time off work for appointments.