Many patients do not receive recommended nutritional care after bariatric surgery
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In the United Kingdom, researchers found varying levels of compliance among general practitioners in providing their patients with recommended nutritional care after bariatric surgery.
The U.K.’s National Institute for Health and Care Excellence recommends that patients who undergo bariatric surgery remain under the care of a specialist for 2 years, then be discharged to a general practitioner for yearly assessments via a shared-care model with a bariatric specialist, Helen M. Parretti, MA, PhD, MSc, a consulting clinical senior lecturer at Norwich Medical School in the U.K., and colleagues wrote in the British Journal of General Practice. These assessments include blood tests to screen for nutritional intake and weight measurements.
Although bariatric surgery provides “multiple health benefits,” a lack of follow-up care may cause nutritional deficiencies that lead to night blindness, cardiomyopathy and neuropathy that can sometimes be fatal, according to the researchers.
Citing concerns that patients are not being adequately monitored, “resulting in risk of avoidable harms and outcomes not being optimized,” Parretti and colleagues assessed general practitioners’ adherence to the U.K.’s post-bariatric surgery guidelines. The analysis included 3,137 patients who underwent a bariatric surgical procedure. The median physician follow-up among the patients was 5.7 years.
According to Parretti and colleagues, between 45% and 59% of the entire cohort had an annual weight measurement. Of the 1,400 patients who underwent laparoscopic adjustable gastric banding, 44.9% had a recorded HbA1C level compared with 61.2% of the 1,067 patients who underwent gastric bypass.
The researchers also reported that the proportion of blood tests were low. For example, only 1.5% of 1,067 patients who underwent gastric bypass had a copper measurement 2 to 3 years after their procedure, and just 1.2% of 818 patients who underwent the same procedure had this measurement taken 3 to 4 years later.
In addition, between 5.9% and 6.9% of patients who had laparoscopic adjustable gastric banding received a multivitamin prescription in each given year compared with 42.4% to 43.7% of patients who underwent gastric bypass. Among the latter cohort, between 37.8% and 42.6% received prescriptions for iron, between 37.2% and 40% were prescribed vitamin B12, between 10% and 10.4% were prescribed calcium/vitamin D, and between 48.5% and 53.8% were prescribed folic acid. Among the 446 patients who underwent a sleeve gastrectomy, 8.3% had a prescription for folic acid and 31.2% for vitamin D between years 2 and 3 after their surgery.
“This study suggests that patients are not receiving the recommended nutritional care post-specialist discharge in terms of monitoring and treatment, increasing the risk of preventable adverse outcomes,” Parretti and colleagues wrote. “The importance of appropriate follow-up post-bariatric surgery should be emphasized to health care professionals and patients, and [general practitioners] supported to provide this care.”