BS O08 The burden of bariatric health tourism on publicly funded health services in the UK

Abstract

Abstract Background Bariatric surgery is a safe and effective treatment for obesity and it's associated co-morbidities. Limited access to surgery in the NHS and a combination of cheaper costs and aggressive advertising by international clinics has led to a surge in people seeking surgery abroad. There is a perception that an indeterminate volume of bariatric health tourism has resulted in increased rate of serious complications in UK. This study aimed to objectively quantify this perceived burden by describing the presentation, management and outcomes of bariatric emergencies in cases undertaken abroad and comparing them to emergency cases originating in the UK. Methods This was a retrospective review of all consecutive non-elective attendances and admissions between January 2018 and April 2023. The setting was a regional bariatric and metabolic surgery centre with a dedicated bariatric on-call service serving Greater Manchester and the North-West of England. Patient demographics, data on index procedures, diagnostic and therapeutic interventions as well as length of hospital and ITU stay was collected. Changes in trends in patients undergoing their index procedure abroad (bariatric health tourist BHT group) were explored and compared to those undergoing surgery in the UK (UK group). Results 373 non-elective episodes were included; 28% related to index procedures abroad. The proportion of admissions related to BHT was 35.5% (17/48), 21% (10/48), 16.5% (9/54), 17% (6/35) and 36.5% (47/128) in years 1 to 5 respectively. BHT patients presented were most likely to present with sleeve complications (33% vs UK 20%) whilst UK patients were most likely to present with band-related problems (46% vs BHT 20%). BHT patients underwent 124 fluoroscopies, 115 CT-scans and 60% required surgical interventions. BHT patients accounted for 37% of total bed days (1610/4311) and had longer median ITU stays (8 v 3 days). Conclusions The total number of emergency episodes related to bariatric surgery undertaken abroad increased eight-fold in the last 12 months compared to the preceding year, and was higher than the total number of episodes in the preceding 4 years. This reflects the ongoing challenges with patient access to publicly funded and affordable bariatric surgery in the UK. Complications arising in this patient group result in longer stays and greater resource burden compared to those patients who have undergone surgery in the UK. This trend has enormous resource implications for service design and an urgent response is needed.