Post-Operative Safety Outcomes and 5-Year Healthcare Utilisation After Bariatric Surgery vs. Other Elective Types of Surgical Treatments - A Retrospective Observational Cohort Study.

OBJECTIVE

To assess safety and healthcare utilization (HU) after metabolic/bariatric surgery (MBS) and compare it to commonly performed general surgery procedures for benign indications. RESEARCH DESIGN AND

METHODS

Data obtained from a nationwide database (NHS Digital) on 800 consecutive patients who underwent bariatric surgery (n = 100) and seven other types of surgery (n = 100 for each) for non-acute, non-cancer indications at a tertiary hospital in England. Non-MBS procedures included adrenalectomy, gastro-esophageal junction surgery (GEJ), in-patient cholecystectomy (IC), outpatient cholecystectomy (OC), colorectal surgery (CR), hernia surgery (HS) and neck endocrine surgery (NES).

RESULTS

Despite a higher number of preoperative co-morbidities and ASA score, MBS had significantly lower odds of 30-day major complications (Clavien–Dindo grade≥IIIa) compared to CR (6%;p = 0.013) and GEJ (8%;p = 0.004). No differences in complication rates with all other groups. The total number of procedure-related readmissions over 5-year after MBS were similar to HS, NES or IC and lower than CR, AS, and GEJ. The average per-patient 5-year cost of procedure-related readmissions after MBS was £790 + 337, lower than for CR (£8,270 + 3218, p < 0.001), AS (£3242 + 772, p < 0.001) and GEJ (£1705 + 976, p = 0.013) and similar to other procedures. There was a higher number of outpatient visits after MBS in the first two years after surgery, consistent with national protocols and no differences in 5-year A&E attendance among groups.

CONCLUSIONS

MBS is associated with a relatively low risk of post-operative complications and 5-year healthcare use compared to other commonly used types of surgical treatments. These findings could help dispel misperceptions that undermine access to effective treatment of obesity.