Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study.

Background: Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. Objective: To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Design: Prospective observational cohort study. Setting: National Health Service secondary care and private practice in Scotland, United Kingdom. Participants: Adults (age >16 years) undergoing their first bariatric surgery procedure. Main outcome measures: Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Data sources: Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Results: Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was -19.0% (±14.1) from the operation and -24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was -5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression. Limitations: Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. Conclusions: Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed. Future work: Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness. Study registration: This study is registered as ISRCTN47072588. Funding details: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.

Bariatric surgery is performed on the stomach and small bowel to help people living with obesity lose weight. Our research study has looked at who is getting bariatric surgery, if they are having problems afterwards, how much weight they lose and if their medical conditions improve. A total of 444 people who were attending bariatric surgery services in Scotland, UK, agreed to take part and 336 had surgery. One hundred and eighty-nine of them completed a questionnaire before their surgery and 85 of them after 3 years, to tell us about how they were feeling physically and mentally. We looked at their computer hospital records to see how long they spent in hospital, any medical problems and changes to diabetes medicines and tests. One in five people taking part did not have surgery after all; they changed their mind or the hospital teams did not think it would be safe or work well for the patient. Those who had surgery lost 19% of their body weight and those with type 2 diabetes needed less or no medication 3 years after the surgery. The effect of physical symptoms on day-to-day activities improved but mental health did not. Compared to other countries, the people taking part were older, heavier and sicker. They spent longer in hospital after surgery and were more likely to be readmitted to hospital. How many appointments they had or what type of health professional they saw before or after surgery did not change these results. We had hoped to have far more people in this study and be able to answer more questions, but not enough people were getting bariatric surgery in Scotland for us to ask them to take part. Further research is needed to find the best ways to care for people living with obesity who would benefit from bariatric surgery.

Quantitative Assessment of Secondary Healthcare Utilisation by Patients With Functional Abdominal Pain.

There is increasing awareness of the impact functional conditions have on the National Health Service (NHS). Less is known about the resources used to manage these conditions. This retrospective quantitative audit aims to determine the demographic and healthcare utilisation of functional abdominal pain patients presenting to the hospital. The most frequent hospital attenders with non-specific abdominal pain in NHS Grampian, 2018-2019, were assessed (n=144). Adult patients meeting the ROME II diagnostic criteria for functional abdominal pain diagnosis were included (n=33). Data were retrospectively collected manually from electronic medical records. Of 33 patients, 93.9% were female, with a mean age of 31.2 years. Each had accessed a mean of 11.5 specialist services, with 69.7% being referred to mental health services; 9.1% had completed treatment. Each patient had a median 4 (range 1-26) emergency/unscheduled presentations to hospital and median 2 (range 0-13) admissions for functional abdominal pain during the study period, with a total of 247 nights spent in hospital by this patient cohort for functional abdominal pain alone. The estimated total cost for these hospital admissions was £593,786.00. Extensive secondary-care input is currently required for patients with functional abdominal pain at a significant cost. Patients are re-presenting to the hospital frequently, which suggests that current management is not effective.

SurgiCal Obesity Treatment Study (SCOTS): a prospective, observational cohort study on health and socioeconomic burden in treatment-seeking individuals with severe obesity in Scotland, UK.

OBJECTIVES: There is a lack of evidence to inform the delivery and follow-up of bariatric surgery for people with severe obesity. The SurgiCal Obesity Treatment Study (SCOTS) is a national longitudinal cohort of people undergoing bariatric surgery. Here, we describe characteristics of the recruited SCOTS cohort, and the relationship between health and socioeconomic status with body mass index (BMI) and age. PARTICIPANTS/METHODS: 445 participants scheduled for bariatric surgery at any of 14 centres in Scotland, UK, were recruited between 2013 and 2016 for this longitudinal cohort study (1 withdrawal); 249 completed health-related preoperative patient-reported outcome measures. Regression models were used to estimate the effect of a 10-unit increase in age or BMI, adjusting for sex, smoking and socioeconomic status. RESULTS: Mean age was 46 years and median BMI was 47 kg/m2. For each 10 kg/m2 higher BMI, there was a change of -5.2 (95% CI -6.9 to -3.5; p<0.0001) in Rand 12-item Short Form Survey Physical Component Summary (SF-12 PCS), -0.1 (95% CI -0.2 to -0.1; p<0.0001) in EuroQoL 5-level EQ-5D version index score and 14.2 (95% CI 10.7 to 17.7; p<0.0001) in Impact of Weight on Quality of Life-Lite Physical Function Score. We observed a 3.1 times higher use of specialist aids and equipment at home (OR: 3.1, 95% CI 1.9 to 5.0; p<0.0001). Broadly, similar results were seen for each 10-year higher age, including a change of -2.1 (95% CI -3.7 to -0.5; p<0.01) in SF-12 PCS. CONCLUSIONS: A higher BMI combined with older age is associated with poor physical functioning and quality of life in people seeking bariatric surgery treatment. Policy-makers must consider the health and care needs of these individuals and invest to provide increased access to effective weight management. TRIAL REGISTRATION NUMBER: ISRCTN47072588.

Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs.

BACKGROUND: We undertook a survey of all bariatric centres in Scotland in order to describe current pre- and post-operative care, to estimate their costs and explore differences in financial impact. METHODS: A questionnaire was distributed to each health centre. Descriptive statistics were used to present average cost per patient along with 95% confidence intervals, and the range of costs. RESULTS: Results show nearly a five-fold difference in costs per patient for pre-operative services (range £226 - £1071) and more than a three-fold difference for post-operative services (range £259 - £896). CONCLUSIONS: There is a lack of evidence base and a clear requirement for the evaluation of bariatric surgical services to identify the care pathways pre- and post-surgery which lead to largest improvements in health outcomes and remain cost-effective.

SurgiCal Obesity Treatment Study (SCOTS): protocol for a national prospective cohort study of patients undergoing bariatric surgery in Scotland.

INTRODUCTION: The efficacy of bariatric surgery for large-scale, long-term weight loss is well established. However, many questions remain over the continual benefits and cost-effectiveness of that weight loss for overall health, particularly when accounting for potential complications and adverse events of surgery. Health research institutes in the UK and the USA have called for high-quality longitudinal cohort studies of patients undergoing bariatric surgery, assessing outcomes such as surgical complications, mortality, diabetes remission, microvascular complications, cardiovascular events, mental health, cost and healthcare use. METHODS AND ANALYSIS: SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational, cohort study of patients undergoing primary bariatric surgical procedures in Scotland. This study aims to recruit 2000 patients and conduct a follow-up for 10 years postbariatric surgery using multiple data collection methods: surgeon-recorded data, electronic health record linkage, and patient-reported outcome measures. Outcomes measured will include: mortality, weight change, diabetes, surgical, cardiovascular, cancer, behavioural, reproductive/urological and nutritional variables. Healthcare utilisation and economic productivity will be collected to inform cost-effectiveness analysis. ETHICS AND DISSEMINATION: The study has received a favourable ethical opinion from the West of Scotland Research Ethics committee. All publications arising from this cohort study will be published in open-access peer-reviewed journals. All SCOTS investigators (all members of the research team at every recruiting site) will have the ability to propose research suggestions and potential publications using SCOTS data; a publications committee will approve all requests for use of SCOTS data and propose writing committees and timelines. Lay-person summaries of all research findings will be published simultaneously on the SCOTS website (http://www.scotsurgeystudy.org.uk).

Post surgical review of bariatric surgery patients: a feasibility study of multidisciplinary follow up using videoconferencing.

BACKGROUND: Bariatric surgery is an effective means of managing weight and reducing medical co-morbidities in the obese patient. However, psychological difficulties are common and adequate multidisciplinary support is vital for post-surgical success. Videoconferencing is potentially a vehicle for the delivery of support to patients residing in remote areas. METHODS: Ten patients were invited to attend a videolink session utilising videoconferencing technology to allow clinicians to connect audio-visually with patients from two remote locations. Seven patients attended. A Consultant Surgeon, Clinical Psychologist and Specialist Dietitian reviewed the patients. Patients and clinicians completed a post-session evaluation questionnaire and commented on their experience. RESULTS: The videolink session was evaluated as acceptable and useful to both patients and clinicians. Patients and clinicians were satisfied with the user-friendliness of the technology. CONCLUSION: Videolink technology may be a viable and accessible means of delivering specialist multidisciplinary input to bariatric patients. Further research is necessary.

Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland.

INTRODUCTION: Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre. PATIENTS AND METHODS: A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy. RESULTS: A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM. CONCLUSIONS: Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common.