Quality statement 6: Follow-up care after bariatric surgery

Quality statement

People who have had bariatric surgery have a postoperative follow-up care package within the bariatric surgery service for a minimum of 2 years.

Rationale

The consequences of poor follow-up care after bariatric surgery can be severe and include weight regain, depression, nutritional deficiencies, osteoporosis, anaemia and death. Psychological screening and support after surgery, dietary advice and support, and specialist physical activity can ensure that the benefits of surgery are maximised.

Quality measures

Structure

Evidence of local arrangements to ensure that people who have had bariatric surgery are offered a follow-up care package within the bariatric service for a minimum of 2 years.

Data source: Local data collection.

Process

Proportion of people who have had bariatric surgery who have a follow-up care package within the bariatric service for a minimum of 2 years after bariatric surgery.

Numerator – the number in the denominator who have a postoperative follow-up care package within the bariatric service.

Denominator – the number of people who had bariatric surgery within the past 2 years.

Data source: Local data collection.

Outcome

a) Nutritional status in the first 2 years following bariatric surgery.

Data source: Local data collection.

b) Patient satisfaction with bariatric surgery.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary, community based, and secondary care tier 3 or tier 4 services) ensure that people who have had bariatric surgery are offered a follow-up care package within the bariatric service for a minimum of 2 years.

Healthcare professionals (bariatric surgery service staff) offer people who have had bariatric surgery follow-up care for at least 2 years after their operation.

Commissioners (clinical commissioning groups and NHS England) ensure that bariatric surgery services they commission offer a follow-up care package within the bariatric service for a minimum of 2 years after surgery. In addition, commissioners ensure that there are agreed local arrangements setting out which services will provide aspects of care (for example, a person's GP may be involved in requesting blood tests or review appointments).

What the quality statement means for patients and carers

People who have had an operation to help them lose weight (called bariatric surgery) have follow-up carefrom the bariatric surgery service for at least 2 years after their operation. Follow-up care includes regular health check-ups, tests to make sure they are getting the nutrients they need, support with their diet, help to increase physical activity and psychological support if needed.

Source guidance

Definitions of terms used in this quality statement

Follow-up care package

This should be for a minimum of 2 years and include:

  • monitoring nutritional intake (including protein and vitamins) and mineral deficiencies

  • monitoring for comorbidities

  • medication review

  • dietary and nutritional assessment, advice and support

  • physical activity advice and support

  • psychological support tailored to the individual

  • information about professionally-led or peer-support groups.

[Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.12.1]

For the first 2 years after surgery, follow-up appointments are likely to be with a dietitian or a bariatric physician. It is assumed that in the first year the person has 3 follow-up appointments, with annual follow-up thereafter. After the first 2 years, follow-up appointments are likely to be with either a dietitian or a GP within a locally agreed shared-care protocol.

[Obesity: identification, assessment and management (NICE full guideline CG189), section 8.1.3.2]