1. NCEPOD Launch Too Lean a Service
NCEPOD Launch Too Lean a Service? London, October A review of patients who underwent bariatric surgery
David Kerrigan
Medical Director & Consultant Surgeon
Phoenix Health

2. Some numbers Cost of obesity to the UK £7.9 Billion1
Predicted cost by 2050 £50 Billion
1 House of Commons Library, Statistics on Obesity Briefing Paper April 2011

3. Prevention is better than cure

4. Prevention is cheaper than cure

5. Prevention doesn’t help the one million people who already have BMI >40

7. Bariatric Surgery in a High Volume Unit
Liverpool Audit
30 Day Mortality
1 death/ 1,334 ops = 0.07%

8. Fact ?
Bariatric surgery is not dangerous

9. Deaths NCEPOD report

10. Deaths No deaths reported in 397 patients
Almost half patients surveyed had gastric banding

11. Deaths RC Histopatholgists Audit n=29
A third of deaths (10/29) due to anastomotic leak
10% from bleeding

12. NCEPOD Hospital Volume
Almost half of hospitals carrying out gastric banding do < 10 per year
Main results is a lack of experience in out-patient care
Poor weight loss
Late recognition remediable complications

13. NCEPOD Hospital Volume
50% bypasses done in high volume units (>40/yr)
25% bypasses in units doing <10/yr

14. Hospital Infrastructure
23% (14/62) private hospitals fall outside new IHAS critical care guidance (level 1 only)
Almost 10% (10/105) hospitals did not offer follow-up clinics

15. Critical Care
97% of patients do NOT require unexpected critical care admission

16. Unplanned Readmissions

19. Gastric Balloon
60% of all balloon patients are readmitted within 6 months
Presumably not to have planned removal!
Early vomiting very common

20. Gastric Band A Safe Operation ?
18% of bands require readmission
Half of band readmissions (9% of all band patients) require reoperation

21. Gastric Band A Safe Operation ?
Most reoperations (60%) for minor port problems
But 3.5% of all bands require early reoperation for more serious complications

22. Gastric Bypass
25% of readmissions for symptoms suggestive of stomal ulcer/stricture
A third of bypass readmissions required surgery

23. Audit Although only 57% entered on to NBSR……
81% entered on to some audit/data registry

24. Surgery on low BMI patients (BMI 30-35)
Balanced view taken regarding application NICE guidelines

25. Medical vs Surgical Treatment BMI 30-35 Randomised Trial
Intensive Medical Treatment
Orlistat
+ VLCD (Optifast)
+ Behavioural Therapy
Bariatric Surgery
Gastric banding vs

26. Medical vs Surgical Treatment BMI 30-35 Results after 2 years
O’Brien P, Dixon J et al; Ann Int Med 2006
Medical
18%
excess weight lost
Surgery
68%
excess weight lost vs

27. Conclusions Well written, balanced report
Full of good suggestions for best practice
(although a few recommendations a bit overly dogmatic)

28. Conclusions
Overall standard of bariatric surgery in UK appears to be high
Need to address low volume, poorly delivered services
Need further study to investigate relationship between volume and outcome