Guidelines for the follow‐up of patients undergoing bariatric surgery

Abstract

Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…Accordingly, weight stabilisation after surgery is also important to prevent OSA or worsening of OSA. Recent guidelines suggest that patients with known OSA should bring their CPAP or BiPAP devices with them for surgery and continue to use it for 3-6 months post-surgery [61]. Thereafter, patients should be reviewed by the respiratory physician in order to determine whether the BiPAP /CPAP pressures need to be adjusted and if a new sleep respiratory assessment should be undertaken.…”

“…Although bariatric surgery is associated with significant improvement of several cardiovascular risk factors, a large proportion of patients undergoing bariatric surgery may remain at high risk for cardiovascular disease. Accordingly, regular monitoring of serum lipids and therapeutic strategies to prevent cardiovascular disease are recommended [6,61,64]. Recent guidelines underscore that the effect of weight loss on dyslipidaemia is variable and incomplete; therefore, lipid-lowering medications should not be stopped unless clearly indicated [6], and patients with dyslipidaemia and on lipid-modifying medications should be re-assessed by performing fasting lipid profiles periodically, including re-assessment of cardiovascular risk status [61].…”

“…Accordingly, regular monitoring of serum lipids and therapeutic strategies to prevent cardiovascular disease are recommended [6,61,64]. Recent guidelines underscore that the effect of weight loss on dyslipidaemia is variable and incomplete; therefore, lipid-lowering medications should not be stopped unless clearly indicated [6], and patients with dyslipidaemia and on lipid-modifying medications should be re-assessed by performing fasting lipid profiles periodically, including re-assessment of cardiovascular risk status [61]. The European Society of Cardiology and European Atherosclerosis Society recently published guidelines for the management of dyslipidaemias, including practical evidence-based advices that may be helpful for bariatric physicians [64].…”

‘The rollercoaster of follow‐up care’ after bariatric surgery: a rapid review and qualitative synthesis

“…Following bariatric surgery, patients become vulnerable to procedure specific problems, which can have longer term consequences. These include a risk of nutritional deficiencies such as protein malnutrition (12)(13)(14), micronutrient or vitamin deficiencies (15)(16)(17)(18) and eating behaviour problems and dumping syndrome (a condition where the intake of high sugar content foods results in symptoms such as sweating, flushing, diarrhoea, abdominal pain and dizziness) (12,(19)(20)(21). Bariatric surgery has a profound effect on patients' pre-existing comorbidities, and the management of these conditions also needs to be modified and monitored following surgery (3).…”

A review of systematic reviews on the effects of patient‐reported outcome monitoring with clinical feedback systems on health‐related quality of life—implications for a novel technology in obesity treatment

“…Studies also suggest a higher prevalence of alcohol‐use disorder after bariatric surgery compared to baseline measures and matched controls . Combined, these findings highlight a need to develop better strategies for mental health follow‐ups of patients after bariatric surgery .…”