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NCEPOD Launch Too Lean a Service? London, October 2012 A review of - - PowerPoint PPT Presentation
NCEPOD Launch Too Lean a Service? London, October 2012 A review of - - PowerPoint PPT Presentation
NCEPOD Launch Too Lean a Service? London, October 2012 A review of patients who underwent bariatric surgery David Kerrigan Medical Director & Consultant Surgeon Phoenix Health Some numbers Cost of obesity to the UK 7.9 Billion 1
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Prevention is better than cure
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Prevention is cheaper than cure
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Prevention doesn’t help the one million people who already have BMI >40
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Bariatric Surgery in a High Volume Unit
Liverpool Audit 2007-2010 30 Day Mortality 1 death/ 1,334 ops = 0.07%
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Fact ?
Bariatric surgery is not dangerous
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Deaths NCEPOD report
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Deaths
- No deaths reported in 397 patients
- Almost half patients surveyed had gastric banding
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Deaths RC Histopatholgists Audit n=29
- A third of deaths (10/29) due to anastomotic leak
- 10% from bleeding
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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
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NCEPOD Hospital Volume
- 50% bypasses done in high volume units (>40/yr)
- 25% bypasses in units doing <10/yr
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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
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Critical Care
- 97% of patients do NOT require unexpected critical
care admission
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Unplanned Readmissions
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Gastric Balloon
60% of all balloon patients are readmitted within 6 months
- Presumably not to have planned removal!
- Early vomiting very common
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Gastric Band
A Safe Operation ? 18% of bands require readmission
Half of band readmissions (9% of all band patients) require reoperation
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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
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Gastric Bypass
- 25% of readmissions for symptoms suggestive of
stomal ulcer/stricture
- A third of bypass readmissions required surgery
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Audit
- Although only 57% entered on to NBSR……
- 81% entered on to some audit/data registry
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Surgery on low BMI patients (BMI 30-35)
- Balanced view taken regarding application NICE
guidelines
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Medical vs Surgical Treatment
BMI 30-35 Randomised Trial
Intensive Medical Treatment
Orlistat + VLCD (Optifast) + Behavioural Therapy
vs
Bariatric Surgery
Gastric banding
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Medical vs Surgical Treatment
BMI 30-35 Results after 2 years
Medical
18% excess weight lost
vs
Surgery
68% excess weight lost
O’Brien P, Dixon J et al; Ann Int Med 2006
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Conclusions
- Well written, balanced report
- Full of good suggestions for best practice
(although a few recommendations a bit overly dogmatic)
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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