BS O06 The burden of bariatric-related emergency interventions at a tertiary bariatric centre: The Luton and Anglian Experience
Authors: Aly Mohamed , Ahmed Safia , Minali Perera H , Arhi Chanpreet , Jain Vigyan , Adil Tanveer , Whitelaw Douglas , Al-Taan Omer , Jambulingam Periyathambi , Munasinghe Aruna 
Published: December 2022

Abstract

Background
Bariatric surgery is becoming more prevalent worldwide due to increasing rates of obesity. British patients can access bariatric surgical services through established NHS services, or privately via British hospitals or abroad. Post-operatively, patients might require urgent surgical admission for analgesia, nutritional evaluation and even emergency surgery. Few publications have addressed the rates of late endoscopic or surgical re-intervention in British bariatric patients. This study investigated the burden of emergency bariatric-related surgery at an established high volume bariatric centre.

Methods
All bariatric-related procedures were selected from a prospectively maintained emergency surgery database. Patients who underwent unplanned, endoscopic or surgical procedures between September 2018 and September 2021 were included. Patients who had bariatric surgery at our institution and returned to theatre within their inpatient stay were excluded.
Primary outcomes were the location of the index procedure (local, other institutions within the UK, or abroad), type of the index bariatric procedure, length of stay (LOS), admission to intensive care, and mortality.

Results
During the study period, 87 patients underwent 102procedures. Index procedures were roux-en-Y gastric bypass 32 (37%), gastric banding 28 (32%), balloon insertion 12 (14%), sleeve gastrectomy 7 (8%), one-anastomosis gastric bypass 4 (5%) and band-to-sleeve gastrectomy revision 3 (3%). 34 (39%) patients had their initial procedure at our unit, 36 (41%) at another British centre and 17 (20%) abroad. The commonest index procedure to require emergency reintervention of those who had surgery at our hospital was the roux-en-Ygastric bypass (26%). Amongst those who had surgery at another UK hospital, it was the gastric band (28%), and intragastric balloons (6%) in the abroad group.
The most common emergency procedures performed for patients from our centre were OGD 11 (11%) and redo jejuno-jejunostomy 7 (7%). Patients from other UK centres required removal of gastric bands 25 (25%) and removal of intragastric balloons 4 (4%). Patients who underwent surgery abroad required OGD 5 (5%), removal of gastric balloons 5 (5%) or gastric bandremoval 4 (4%).
Median length of stay was 4 days (IQR 3.9–12.7). There were 9 (9%) admissions to ITU. There were two mortalities (2%), one patient from our hospital and onepatient from another British centre.

Conclusions
Our centre experiences a high volume of bariatric surgical emergencies that are promptly managed surgically and endoscopically with increased demand from patients who underwent bariatric surgery abroad. More than a third of patients are from other British centres reflecting the importance of established regional networks for the specialised care of these patients, while a fifth underwent surgery abroad. Further work should involve exploring factors affecting patients decision to seek private bariatric surgery, within the UK or abroad, and a consideration of the cost-burden to the NHS.