Departments of Neurology, Magee Campus, Londonderry BT48 7JL.
Endocrinology & Diabetes, Magee Campus, Londonderry BT48 7JL.
Ulster Med J. 2024 Jan;93(1):6-11. Epub 2024 May 3.
Since the start of the Covid-19 pandemic primary and secondary health care services in Northern Ireland have observed an increase in the number of patients who have had bariatric surgery outside of the UK. This study sought to estimate the frequency of bariatric surgery tourism and to audit indications, blood monitoring and medical complications.
All primary care centres within the Western Health Social Care Trust (WHSCT) were invited to document the number of patients undergoing bariatric surgery between January 1, 2017 and December 31, 2022. For one primary care centre, patients who underwent bariatric surgery were assessed against the National Institute of Health and Clinical Excellence (NICE) guideline indications for bariatric surgery. In addition, the blood monitoring of these patients was audited against the British Obesity and Metabolic Surgery Society (BOMSS) guidelines for up to two years following surgery. Medical contacts for surgical complications of bariatric surgery were recorded.
Thirty-five of 47 (74.5%) GP surgeries replied to the survey, representing 239,961 patients among 325,126 registrations (73.8%). In the six year study period 463 patients had reported having bariatric surgery to their GP. Women were more likely to have had bariatric surgery than men (85.1% versus 14.9%). There was a marked increase in the number of patients undergoing bariatric surgery with each year of the study (p<0.0001 chi square for trend). Twenty-one of 47 patients (44.7%) evaluated in one primary care centre fulfilled NICE criteria for bariatric surgery. The level of three-month monitoring ranged from 23% (for vitamin D) to 89% (electrolytes), but decreased at two years to 9% (vitamin D) and 64% (electrolytes and liver function tests). Surgical complication prevalence from wound infections was 19% (9 of 44). Antidepressant medications were prescribed for 23 of 47 patients (48.9%).
The WHSCT has experienced a growing population of patients availing of bariatric surgery outside of the National Health Service. In view of this and the projected increase in obesity prevalence, a specialist obesity management service is urgently required in Northern Ireland.
自新冠疫情开始以来，北爱尔兰的初级和二级保健服务机构注意到，在英国以外接受过减重手术的患者数量有所增加。本研究旨在估计减重手术旅游的频率，并对其适应证、血液监测和医疗并发症进行审核。
邀请 Western Health Social Care Trust（WHSCT）内所有初级保健中心记录 2017 年 1 月 1 日至 2022 年 12 月 31 日期间接受减重手术的患者数量。对于一个初级保健中心，对接受减重手术的患者根据国家卫生与临床优化研究所（NICE）的减重手术适应证进行评估。此外，根据英国肥胖与代谢外科学会（BOMSS）的指南，对这些患者术后两年的血液监测情况进行审核。记录与减重手术相关的手术并发症的医疗联系。
47 家全科手术中有 35 家（74.5%）对调查做出了回应，代表了 325126 名患者中的 239961 名（73.8%）。在六年的研究期间，有 463 名患者向全科医生报告了接受过减重手术。女性接受减重手术的可能性高于男性（85.1%对 14.9%）。随着研究年份的增加，接受减重手术的患者数量显著增加（p<0.0001，趋势性卡方检验）。在一个初级保健中心评估的 47 名患者中有 21 名（44.7%）符合 NICE 减重手术标准。三个月监测的水平范围从 23%（维生素 D）到 89%（电解质），但两年后降至 9%（维生素 D）和 64%（电解质和肝功能检查）。手术并发症的发生率为 19%（44 例中有 9 例），包括伤口感染。47 名患者中有 23 名（48.9%）开了抗抑郁药。
WHSCT 经历了接受国民保健制度以外减重手术的患者人数不断增加。鉴于此，以及肥胖症患病率预计会增加，北爱尔兰迫切需要一个专门的肥胖症管理服务。
