Bariatric surgery failures 'leave GPs in the lurch'
A national audit has uncovered serious failures in the care of obese patients undergoing bariatric surgery, with more than one in every six patients readmitted within six months of the procedure.
GPs are frequently left to pick up the pieces after bariatric surgery with little or no information on how to care for the patient, the panel of independent experts concluded.
A review of the care of almost 400 patients undergoing bariatric surgery in a three-month period found 18% of patients were readmitted within the first six months of surgery.
A third did not receive proper follow up in the six months after their operation and 44% had their first follow up appointment more than six weeks after surgery. One in five discharge summaries were found to be ‘poor or unacceptable’, the audit found.
This was despite 8,000 people undergoing bariatric surgery in 2010/11 – an increase of more than 90% from two years previously.
The National Confidential Enquiry into Patient Outcome and Death found bariatric surgery was often seen as a ‘quick fix’ and carried out without proper consideration of the risks or adequate follow up.
Consent processes also came in for criticism and the report said patients should not be presented with information on the risks of surgery on the same day of their operation but have time to consider what they were agreeing to. Only 29% had received any psychological testing before referral for surgery.
Around 60% of all patients reviewed had been referred by their GP but almost half of patients had paid privately for weight loss surgery.
The authors concluded: ‘Given the potential for significant metabolic after bariatric surgery, good quality care is supported if patients have clear post-operative dietary guidance and a timely and complete discharge summary, with full clinical detail and post discharge plan to ensure safe and seamless care.
‘This must be provided to the GP as soon as possible following discharge, preferably within 24 hours.’
Dr Andrew Brewster, a GPSI in obesity and diabetes lead for Berkshire, agreed that surgery was an effective option, but in the UK ‘we are not doing it properly’.
He said: ‘I’ve had patients for whom the follow up has been pretty poor. The surgeons think you’re fixed, off you go and they’re left to primary care to deal with.
‘Obesity surgery is about a whole package of change. As it becomes more common we are going to have a situation where GPs are just left in the lurch not knowing how on earth the manage these patients and that is a real problem.’
Professor David Haslam, a GP in Watton-at-stone, Hertfordshire and one of the authors of the report, said it must be an ‘absolute priority’ is to improve discharge communication, and this was a particular problem in the private sector.
He said: ‘Patients are being discharged into the community who had diabetes but now their diabetes could disappear within days, yet they are still on insulin.
‘The GP doesn’t even know that patient had gone in for surgery or had any information about follow up.’
Bariatric surgery, in numbers
- 90% increase in patients receiving bariatric surgery
- 60% referred by GP
- 29% received psychological counselling
- 32% received adequate follow-up
Source: National Confidential Enquiry into Patient Outcome and Death, Oct 2012