The DUBASCO SCORE: A scoring system for selecting patients for consideration of bariatric surgery

Abstract

The National Institute for Health and Clinical Excellence guidance states that bariatric surgery should be available as a treatment option for people with a body mass index (BMI) of > 40.0 kg/m2and those with a BMI 35.0—40.0 kg/m2and other significant disease that may be improved with weight loss. Despite this, funding criteria are different between primary care trusts (PCTs) in England and some use a cut-off BMI of > 50.0 kg/m2. However, BMI may not be the best parameter to decide on who would benefit most from bariatric surgery. We have developed a scoring system, which takes into account the number and severity of four comorbidities in addition to BMI and age. Using this scoring system, 24% of patients with BMI > 50.0 kg/m2did not score high enough, whereas 63% of patients with BMI 35.0—50.0 kg/m2had significant comorbidities and would have potentially benefited more from undergoing bariatric surgery. The advantage of using a scoring system, is that the cut-off level for referral for surgery can be adjusted up or down depending on the level of resources available, but will always identify those patients who would benefit most from surgery.