A NICE example? Variation in provision of bariatric surgery in England

Abstract

Demand for surgery to treat morbid obesity outstrips supply. Amanda Owen-Smith and colleagues find regional commissioning policies are not consistent with NICE guidance and provision of surgery varies widely Amanda Owen-Smith research fellow

Why the NHS should do more bariatric surgery; how much should we do?:

“…31 32 This prolonged pathway may create inertia and put patients off accessing effective surgical treatment. [28][29][30][31] There are no contractual mandates to fund secondary care clinics, and from April 2016 local commissioning groups will be free to pursue other obesity treatment strategies (and GPs will still not be able to refer directly to surgical services). Without a clear pathway access to surgery may stop.…”

Harveian Oration 2016: Some observations on the causes and consequences of obesity

“…115 This is not that surprising if one considers the mechanisms of lipid overflow and lipotoxicity associated with limited safe fat storage capacity, discussed in detail earlier in this lecture. Unfortunately for M, the UK lags far behind most advanced countries in the provision of 'metabolic surgery' 116 and she will probably face many barriers to accessing this highly successful treatment. 117 The National Institute for Health and Care Excellence (NICE) has recently published a quality standard for the clinical assessment and management of obesity, 118 which includes the explicit recognition of the important role that bariatric surgery plays.…”

The Effect of Intraoperative N-Acetylcysteine on Hepatocellular Injury During Laparoscopic Bariatric Surgery. A Randomised Controlled Trial

“…Inclusion criteria were patients aged 18 to 75 years inclusive, meeting the published National Institute of Clinical Excellence indications for weight loss surgery, that is they must have BMI >40 or >35 kg/m 2 with obesity-related complications and are undergoing laparoscopic sleeve gastrectomy [17]. Patients were excluded if they had a history of chronic liver disease, abnormal hepatitis serology or autoantibody screen, previous liver surgery, a history of active psychiatric illness, a known bleeding tendency or prescribed anticoagulant medications or a known allergy to NAC or related compounds.…”