Bariatric tourism care costs NHS more than actual surgery - study

People who go abroad for weight-loss surgery, and then need urgent medical care back in the UK, cost the NHS more than it costs to carry out the operation itself, according to new research.

A study featuring five London hospitals recorded the details of 35 people who had suffered complications after travelling abroad for gastric surgery during 2022.

The data, shared with the BBC's Disclosure programme, shows the patients suffered from a range of symptoms including severe malnutrition, vomiting, sepsis, hernias and haemorrhaging. Five of them needed feeding tubes inserted, while the average stay in hospital was 22 days.

The interventions at the five hospitals for the 35 patients cost the NHS a total of £560,234, or £16,006 per patient, in 2022.

The equivalent amount would have covered the cost of about 110 bariatric surgeries in UK hospitals.

The paper featured cases at St George's Hospital, University College Hospital, The Whittington Hospital, Imperial College Healthcare NHS Trust and Homerton Hospital, and was carried out on behalf of the patient safety committee of the Bariatric and Obesity Metabolic Surgery Society (BOMSS).

Consultant bariatric surgeon Omar Khan, one of the lead authors of the study, said the paper was intended "to try and quantify" the effect on the NHS of increasing numbers of people going abroad for weight-loss surgery - sometimes known as bariatric tourism.

"We know that the waiting lists in the NHS are unfortunately long. We also know that there are new units, particularly in Turkey, which have been set up to cater for an international market," he explained.

"We focused on patients with major complications, patients who were severely ill. They had leaks from the stomach, they had bleeding, they had infections. A significant portion required further surgery and some required revisional surgery."

Most of the patients (60%) had returned from hospitals in Turkey and 90% of them were women. The most common operation was gastric sleeve followed by gastric balloon, both of which are intended to make patients feel full more quickly, meaning they eat less.

The study also revealed that more than half of the 35 patients would likely have been rejected for surgery on the NHS, while almost 60% did not meet the National Institute for Care and Excellent (NICE) criteria for surgery.

The NICE guidelines are used by the NHS to assess a patient's suitability for bariatric surgery.

One of the main criteria is a patient's body mass index (BMI), a measurement based on height and weight. A patient with a BMI of less than 40, and no severe co-morbidities relating to obesity, would typically be rejected for bariatric surgery in the UK.

Bariatric surgery, also known as weight-loss surgery, is used as a last resort to treat people who are dangerously obese (having a body mass index of 40 or above, or 35 plus other obesity-related health conditions).

Patients must have tried and failed to achieve clinically-beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery.

The two most common types of weight loss surgery are:

It can cost as little as £2,000 to book weight-loss surgery in Turkey. The price to have it done privately in the UK is between £10,000 and £15,000.

The rise in complications as a result of bariatric tourism prompted BOMSS to issue a public warning in October last year.

It said: "As a professional society we are increasingly concerned by the number of patients presenting with the complications of surgical procedures performed outside the UK.

"There is often an assumption that the NHS will sort out any issues once the patient returns home, but this is not always straightforward and has resulted in severely ill patients being repatriated to the UK and presenting themselves to their local A&E department."

Private hospitals in the UK have formal agreements in place with the NHS to recoup the costs of medical interventions.

The study of the cases in London hospitals, titled The London Experience, is currently being peer-reviewed and will be published in full later this year.

Mr Khan said the findings raised questions around NHS policy on bariatric tourism.

"Obviously if someone is in extremis, is unwell, we need to treat them. We have a duty to do that," he said.

"A broader question, though, is more a public policy question. For example, if an NHS hospital deems a patient not suitable for bariatric surgery and they then go abroad to have that surgery, and then have, effectively a predictable complication... is the NHS obligated from a public policy perspective to effectively incentivise that behaviour, by giving a safety net?

"That's not to say we shouldn't be treating people, but it is more a general question at a higher level as to how we should be approaching this."

On its website, the NHS states that people who consider travelling abroad for bariatric surgery should "make sure you weigh up any potential savings against the potential risks.

"Standards may not be as strict in clinics outside the UK, and aftercare is not always straightforward. Clinics in other countries may not provide follow-up care, or it may not be the same standard as in the UK."

The Department of Health (DoH) recently said in a statement there were risks associated with travelling abroad for surgery "which people should consider carefully and fully understand before making their decision.

The department said it was working to develop advice to help people understand the associated challenges and risks, including the need to arrange appropriate follow up care with the private provider.

The public, the department added, could refer to UK-wide information and guidance on medical tourism.

For details of organisations in the UK which offer advice and support with body image and mental health, go to bbc.co.uk/actionline

You can watch BBC Disclosure's Getting Thin Quick on BBC iPlayer

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