BMJ 2014;349:g6735 doi: 10.1136/bmj.g6735 (Published 11 November 2014)
Page 1 of 2
News
NEWS Audit shows that bariatric surgery is cost effective Jacqui Wise London
Two thirds of patients with type 2 diabetes at the time of bariatric surgery showed no indication of diabetes two years later and were able to stop their treatment, data from the National Bariatric Surgery Registry have shown. Commenting on the report1 Clare Marx, president of the Royal College of Surgeons, said, “This audit shows compelling evidence of the cost effectiveness of bariatric surgery for obese patients. Obesity is linked with a number of conditions including diabetes which are not only debilitating for patients but also create a significant financial strain on the NHS.”
The registry included data on 18 283 operations from 2010 to 2013. The data showed that bariatric surgeons were successfully operating on patients, who were getting heavier over this period and having more health complications at the point of surgery. The average body mass index of people undergoing surgery was 48.5 kg/m² in 2010, and this increased to 48.8 kg/m² in 2013—almost twice the ideal weight. From 2010 to 2013 the average number of comorbidities increased from 3.2 to 3.4. At the time of surgery 45% of men and 26% of women had type 2 diabetes, and 40% of men and 26% of women were receiving treatment for sleep apnoea. Almost three quarters of men and women had some functional impairment, meaning that they could not climb three flights of stairs without resting. One year after surgery patients had lost on average 58.4% of their excess weight: 36.6% in patients with gastric banding, 68.7% in those with gastric bypass, and 58.9% in those with
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sleeve gastrectomy. Of the patients with preoperative functional impairment, after one year 64% could climb three flights of stairs without resting.
The data showed that 61% of patients with sleep apnoea were able to come off their treatment after surgery. Also, two years after surgery 65% of patients with type 2 diabetes were reported as having no clinical indication of diabetes, and they were able to stop their diabetic medicine. Those patients who needed insulin before surgery were less likely to revert to a non-diabetic state than those who needed oral hypoglycaemic drugs, and this latter cohort had lower resolution rates than patients treated by diet alone. The observed in-hospital mortality rate after primary surgery was 0.07% overall. The average postoperative stay fell from 3.1 days to 2.7 days over the study period, even though the later patients were on average sicker at the point of surgery and were undergoing more complex operations.
Richard Welbourn, consultant surgeon and chair of the registry, said, “Our data show that there is great benefit from bariatric surgery for all of the diseases studied—in particular, the effect on diabetes has important implications for the NHS. Bariatric surgery cost-effectively improves the health of obese patients.” 1
National Bariatric Surgery Registry. Second registry report. November 2014. http://nbsr. co.uk/.
Cite this as: BMJ 2014;349:g6735 © BMJ Publishing Group Ltd 2014
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BMJ 2014;349:g6735 doi: 10.1136/bmj.g6735 (Published 11 November 2014)
Page 2 of 2
NEWS
Figure
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Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS Audit shows that bariatric surgery is cost effective Jacqui Wise London
Two thirds of patients with type 2 diabetes at the time of bariatric surgery showed no indication of diabetes two years later and were able to stop their treatment, data from the National Bariatric Surgery Registry have shown. Commenting on the report1 Clare Marx, president of the Royal College of Surgeons, said, “This audit shows compelling evidence of the cost effectiveness of bariatric surgery for obese patients. Obesity is linked with a number of conditions including diabetes which are not only debilitating for patients but also create a significant financial strain on the NHS.”
The registry included data on 18 283 operations from 2010 to 2013. The data showed that bariatric surgeons were successfully operating on patients, who were getting heavier over this period and having more health complications at the point of surgery. The average body mass index of people undergoing surgery was 48.5 kg/m² in 2010, and this increased to 48.8 kg/m² in 2013—almost twice the ideal weight. From 2010 to 2013 the average number of comorbidities increased from 3.2 to 3.4. At the time of surgery 45% of men and 26% of women had type 2 diabetes, and 40% of men and 26% of women were receiving treatment for sleep apnoea. Almost three quarters of men and women had some functional impairment, meaning that they could not climb three flights of stairs without resting. One year after surgery patients had lost on average 58.4% of their excess weight: 36.6% in patients with gastric banding, 68.7% in those with gastric bypass, and 58.9% in those with
For personal use only: See rights and reprints http://www.bmj.com/permissions
sleeve gastrectomy. Of the patients with preoperative functional impairment, after one year 64% could climb three flights of stairs without resting.
The data showed that 61% of patients with sleep apnoea were able to come off their treatment after surgery. Also, two years after surgery 65% of patients with type 2 diabetes were reported as having no clinical indication of diabetes, and they were able to stop their diabetic medicine. Those patients who needed insulin before surgery were less likely to revert to a non-diabetic state than those who needed oral hypoglycaemic drugs, and this latter cohort had lower resolution rates than patients treated by diet alone. The observed in-hospital mortality rate after primary surgery was 0.07% overall. The average postoperative stay fell from 3.1 days to 2.7 days over the study period, even though the later patients were on average sicker at the point of surgery and were undergoing more complex operations.
Richard Welbourn, consultant surgeon and chair of the registry, said, “Our data show that there is great benefit from bariatric surgery for all of the diseases studied—in particular, the effect on diabetes has important implications for the NHS. Bariatric surgery cost-effectively improves the health of obese patients.” 1
National Bariatric Surgery Registry. Second registry report. November 2014. http://nbsr. co.uk/.
Cite this as: BMJ 2014;349:g6735 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;349:g6735 doi: 10.1136/bmj.g6735 (Published 11 November 2014)
Page 2 of 2
NEWS
Figure
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