BS O09 Bariatric Medical Tourism - a false economy. A case series of complications and the impact on the NHS

Abstract

Abstract Background Increasing numbers of patients from the United Kingdom are going abroad for treatment, in order to avoid lengthy NHS waiting lists for primary weight loss surgery and to circumvent restrictions on cosmetic operations, post-bariatric surgery. News media often report individual patient stories about post-operative complications. Patients are increasingly accessing NHS emergency services when these occur. The aim of this study was to evaluate the impact on both patients and the NHS from treatment of complications associated with Bariatric medical tourism. Methods A retrospective case study was performed between July 2022-June 2023 at East Surrey Hospital, the nearest hospital to London Gatwick Airport. The study included all patients who presented as an emergency with complications associated with bariatric or post-bariatric procedures performed outside of the UK. Data was collected via electronic patient records, including patient demographics, BMI, original operation, complications, investigations, treatment and length of stay. A cost analysis was performed for each patient’s ‘in-patient’ stay using the ‘NHS Payment Scheme (2023/24)’. Further cost analysis of ongoing community intervention was not performed. Results A total of 15 patients were identified in this time frame. 13 (86.6%) were female with mean age 40 years (range 27-54). Mean BMI was 35 (range 29-44). The most common original operation was post-bariatric Abdominoplasty (46.6%), followed by Laparoscopic Sleeve Gastrectomy (26.6%). 14 (93.3%) patients had their original operation performed in Turkey. Time to emergency presentation ranged from 7-365 days. 66.7% of complications were graded Clavien Dindo score 3 or above. 8 (53.3%) patients required multiple admissions. The average length of stay was 7.5 days (range 1-37). The cost per patient to the NHS averaged at £6857.14 (£600-£28,625). Conclusions This study shows that medical tourism has a significant impact on NHS services, costing over £100,000 in our hospital alone, in one year. Common factors in this patient cohort included poor pre-operative optimisation, continued smoking, vitamin and mineral deficiencies and delayed presentation once complications occurred. Given that medical tourism is increasing, public health education about the risks should increase. Such efforts may mitigate the cost impact on the NHS. It is time for a national registry for international complications and a UK governance strategy is implemented.