Arhi Chanpreet, Karagianni Chrysanthi, Howse Louise, Siddiqui Midhat, Borg Cynthia-Michelle
Lewisham and Greenwich NHS Trust, University Hospital Lewisham, Lewisham High Street, London, SE18 4QH, UK.
Obes Surg. 2021 Jun;31(6):2529-2536. doi: 10.1007/s11695-021-05303-2. Epub 2021 Mar 16.
Despite the recognised advantages of bariatric and metabolic surgery, only a small proportion of patients receive this intervention. In the UK, weight management systems are divided into four tiers. Tier 3 is a clinician-lead weight loss service while tier 4 considers surgery. While there is little evidence that tier 3 has any long-term benefits for weight loss, this study aims to determine whether tier 3 improves the uptake of surgery.
A retrospective cohort study of all referrals to our unit between 2013 and 2016 was categorised according to source-tier 3, directly from the general practitioner (GP) or from another speciality. The likelihood of surgery was calculated using a regression model after considering patient demographics, comorbidities and distance from our hospital.
Of the 399 patients, 69.2% were referred directly from the GP, 21.3% from tier 3, and 9.5% from another speciality of which 69.4%, 56.2%, and 36.8% progressed to surgery (p = 0.01). On regression analysis, patients from another speciality or GP were more likely to decide against surgery (OR 2.44 CI 1.13-6.80 p = 0.03 and OR 1.65 CI 1.10-3.12 p = 0.04 respectively) and more likely to be deemed not suitable for surgery by the MDT (OR 6.42 CI 1.25-33.1 p = 0.02 and OR 3.47 CI 1.11-12.9 p = 0.03) compared with tier 3 referrals.
As patients from tier 3 were more likely to undergo bariatric and metabolic surgery, this intervention remains a relevant step in the pathway. Such patients are likely to be better informed about the benefits of surgery and risks of severe obesity.
尽管减重与代谢手术具有公认的优势，但仅有一小部分患者接受这种干预。在英国，体重管理系统分为四个层级。第三层级是由临床医生主导的体重减轻服务，而第四层级则考虑手术治疗。虽然几乎没有证据表明第三层级对体重减轻有任何长期益处，但本研究旨在确定第三层级是否能提高手术的接受率。
对2013年至2016年间转诊至我们科室的所有患者进行回顾性队列研究，根据来源进行分类——第三层级、直接来自全科医生（GP）或来自其他专科。在考虑患者人口统计学特征、合并症以及与我们医院的距离后，使用回归模型计算手术的可能性。
在399例患者中，69.2%直接由全科医生转诊，21.3%来自第三层级，9.5%来自其他专科，其中分别有69.4%、56.2%和36.8%进展至手术（p = 0.01）。回归分析显示，与第三层级转诊的患者相比，来自其他专科或全科医生转诊的患者更有可能决定不进行手术（分别为OR 2.44，CI 1.13 - 6.80，p = 0.03和OR 1.65，CI 1.10 - 3.12，p = 0.04），并且多学科团队（MDT）更有可能认为其不适合手术（分别为OR 6.42，CI 1.25 - 33.1，p = 0.02和OR 3.47，CI 1.11 - 12.9，p = 0.03）。
由于来自第三层级的患者更有可能接受减重与代谢手术，这种干预仍然是该流程中的一个相关步骤。这类患者可能对手术益处和严重肥胖风险有更充分的了解。
