l

The content of this website is intended for healthcare professionals only

Gastric banding has strong impact on cardio risks

Poor pre-surgery counselling and follow-up endangers patients

Louise Prime

Thursday, 18 October 2012

Bariatric surgery, including gastric banding and bypass surgery, can dramatically reduce cardiovascular risk factors, shows research published online today in Heart. But authors of a new report have warned this morning that patients are being put in danger by poor counselling before surgery about its risks and requirements, and inadequate follow-up.

Researchers in the US undertook a systematic review of research published from 1950 to June this year, on the impact of bariatric surgery on cardiovascular risk factors, heart failure and structural changes to the heart. This included 73 studies involving nearly 20,000 people, of whom three-quarters were women; mean age was 42 years.

Before surgery, 44% of patients had hypertension, 24% diabetes and 44% dyslipidaemia. Over a mean of 4.5 years’ follow up after surgery, patients lost between 16% and 87% of their excess weight, with an average of 54%. Most patients also had a significant improvement, or complete resolution, of their cardiovascular risk factors – 63% for hypertension, 73% for diabetes and 65% for dyslipidaemia.

The authors said that the data, which are in line with previously published studies, mean that bariatric surgery should be regarded as an efficacious, potentially lifesaving, intervention for preventing cardiovascular events, that works more quickly than drugs – rather than a cosmetic procedure.

They conclude: “The magnitude of effect on [cardiovascular] risk factors is impressive, and to date no pharmacological therapy for weight management or diabetes has shown a comparable effect over these short time periods.”

However, they point out that the surgery is not risk free. And the authors of a separate report published this morning by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) warn that bariatric surgery is seen far too often as a ‘quick ‘fix’.

It found that only just over a quarter (29%) of patients received adequate psychological counselling prior to weight-loss surgery, and many underwent the surgery “without proper assessment of the considerable risks the procedure poses to them”.

Almost a third (32%) of patients were not adequately followed up after surgery; 18% had to be readmitted within six months. The authors also pointed out that about half (48%) of hospitals carrying out bariatric surgery performed only 10 or fewer operations annually.

Report co-author and NCEPOD clinical co-ordinator in surgery Mr Ian Martin said: “Bariatric surgery is a radical procedure with considerable risks, as well as benefits. It shouldn’t be undertaken without providing full information and support to patients. But … even the basics, such as giving patients dietary advice and education before decisions to operate are taken, were sometimes lacking.”

NCEPOD recommends that:

  • specialist associations involved with bariatric surgery should provide guidance on the number of procedures surgeons and hospitals need to perform to optimise patient outcomes
  • all patients must have access to the full range of specialist professionals appropriate for their needs in line with NICE guidelines
  • there should be greater emphasis on psychological assessment and support at an early stage in the care pathway
  • a deferred two-stage consent process must be in place so benefits and risks can be clearly spelt out, and not carried out on the day of surgery
  • professional associations and regulators should agree a code of conduct for weight-loss advertisements
  • a clear continuous long-term follow-up plan must be made for every patient undergoing bariatric surgery
  • post-operative dietary guidance for patients is essential to achieve or sustain planned weight loss.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470