Access to Bariatric Surgery In Europe

Introduction

Bariatric surgery not only gives patients a new chance in life, but also facilitates improvements in social and mental status. Initially, guidance towards this life-changing surgery was often performed by the surgeons themselves. Before surgery, the patient had a short consultation and was given only limited information about the surgery and the expected results. The surgeon was often the only health care professional who made a judgment on whether a patient was suitable for bariatric surgery. On average, patients had annual or bi-annual postoperative follow-up. These visits focused in particular on weight loss and reduction in comorbidities. Today we know that this way of selecting and preparing patients for bariatric operations was inadequate. Many questions remained unanswered and patients did not know what to expect. In particular, many patients were unable to cope with the psychological adaptation required to undertake dietary and lifestyle changes to maximise weight loss. Because the number of follow-up visits were limited, many problems were not overcome.

There is a strong need for patients to have access to specialized professionals. In addition, it is very important to have patients screened by a multidisciplinary team before undergoing bariatric surgery. This team can quickly identify problems and can give advice on how to manage these. Although we all agree that morbid obese patients should have access to professional healthcare, we do not know the pathways the patient has to go to gain access. It seems logical that each country in Europe has his own pathways, but which one results in the best outcomes? As described above, there has been rapid growth in the number of patients undergoing bariatric surgery. Proper regulation of screening, follow-up and frequent counselling seems to strongly influence outcomes, like average weight loss. In the long term, a continuous supply of care is important to prevent weight gain. This has resulted in significant logistical issues for many hospitals, as care for each patient must be properly regulated and guaranteed. This care should be given for life, to identify and manage problems as quickly as possible.

In recent years more and more collaboration between hospitals occur and more exchange of knowledge on pre and postoperative care is shared. Different countries have many different protocols to select and guide patients through bariatric surgery, and even within countries differences exist. These are most commonly based on expert opinions and cultural influences. Although many outcomes of the different approaches are known, the pathways the patient has to take and the accessibility to bariatric surgery are unclear for each country as well as how the care for these patients is financially arranged. As a progressive research collaboration, we would like to gain more insight into these different approaches. With this study we would like to gain more insight into the accessibility and restrictions to access to both bariatric surgery and body contouring surgery after massive weight loss that exists in the different European countries, as well as why this disparity exists.

Research aim