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INTRODUCTION

The United Kingdom National Bariatric Surgery Registry Publication of Surgeon-level data in the public domain for bariatric surgery in NHS England

Summary

The National Bariatric Surgical Registry (NBSR) Committee on behalf of the British Obesity and Metabolic Surgery Society and in collaboration with Dendrite Clinical Systems presents the outcomes data for NHS patients having bariatric surgery in England for the four financial years from 2018 to 2023 on https://nbsr.e-dendrite.com.

Background

The National Bariatric Surgical Registry was originally set up a voluntary audit tool to monitor activity and outcomes of bariatric surgery in the UK. Since 2013 data entry for all NHS bariatric cases has been mandated; and following a call for a culture of openness, transparency and candour from the Francis Report (2013), NHS outcomes for bariatric surgery were first published in 2013. Since then the NBSR have published a yearly Consultant-level Outcome Publication (COP) report of the NHS bariatric activity in England.

Summary of National Results

The NHS bariatric activity for each financial year are summarised in the tables below based on a data cut taken from the NBSR database on the 24th November 2023.

As before, this data summarises all NHS funded primary and revisional bariatric surgery.

Revisional surgery is defined as either major (defined as conversions from one bariatric procedure to another for the purpose of weight loss) or minor which includes band port and band removal procedures.

There are a few cases each year which were not recorded by the inputing team as either primary or revisional surgery.

This summary does NOT include the following:

• Patients who self-funded bariatric surgery; or whose operations were funded through insurance
• Patients who had surgery outside England
• Patients who had temporary weight loss interventions (eg gastric balloons)
• Patients who had elective surgery to treat long term complications associated with bariatric surgery (eg gallstones)

It should be noted that data from operations performed in the private sector as well as gastric balloons are recorded in the Registry but the data for these operations are not included in this report as the funding received for analysis was earmarked for NHS activity only. We are however working with the Private Health Information Network to deliver a comparable summary of the activity of bariatric activity in the private sector.

SUMMARY OF PUBLISHED CONSULTANT OUTCOME DATA

• Total number of operations, broken down by common procedures (ie gastric bands, sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass/mini gastric bypass
• Reporting of revisional surgery rates according to major and minor, expressed as % of workload of each surgeon
• Clinical and demographic details of patients undergoing surgery
• Lenght of hospital stay
• In-hospital mortality

Patients are able to search for hospitals by geography using an added map function and postcode. As before, we present data for each outcome variable either as graphs, bar charts or box and whisker graphs. Comments are included to aid interpretation of the results.

SUMMARY OF HOSPITAL AND CONSULTANT DATA OUTLIERS

As per a previous mandate from the Department of Health the NBSR Committee has repeated the outcome measures used in previous COP reports to identify negative outliers (i.e. hospitals and surgeons whose performance in specific areas appear to fall below the expected standards).

In line with our previous analysis we conducted an ascertainment exercise where the number of cases which were recorded on NBSR were compared to those recorded by the NHS Hospital Admission Statistics (HES).

Hospitals where the number of the number of cases recorded on NBSR were 75% or less than those recorded through HES were identified as negative outliers.

For the financial year 2022-2023 the following hospitals were identified as negative outliers:

Churchill Hospital, Oxford
Darlington Memorial Hospital
Dewsbury & District Hospital
Doncaster Royal Infirmary
Homerton University Hospital, London
King's College Hospital, London
Leicester Royal Infirmary
Luton & Dunstable University Hospital
Royal Berkshire Hospital, Reading
Royal Derby Hospital
Solihull Hospital
St George's Hospital, London
St James's University Hospital, Leeds
University College Hospital, London
Worcestershire Royal Hospital
York Hospital

We also analysed the initial operations record for each surgeon to assess data completion for each patient record. A simplified funnel plot was then used to identify surgeons whose the degree of data completion was outside the confidence limits. The NBSR committee has sent several reminders to contributors to check and correct this prior to publishing this report.

For the financial years 2019- 2023 the following surgeons were identified as negative outliers in terms of data completion:

Roger Ackroyd
Kalpana Devalia
Simon Dexter
David Exon
Farhan Rashid
Mathew Giles
Simon Higgs
Abdulzahra Hussain
Ian Maheswaran
John Loy
Rachel Aguilo
James Rink
Bruno Sgromo
Pratik Sufi

It should be noted that there are a number of provisos in interpreting outlier data and the NBSR committee has no further role other than pointing out apparent discrepancies.

For hospital outliers, we would emphasise that there are limitations in the HES coding for bariatric surgery which can impact on the accuracy of comparing their data with the NBSR. It is also possible that individual hospital coding issues are the reason for some of the apparent differences, and these may need assessing locally. It has also been our experience that many NHS bariatric units do not have sufficient administrative support to ensure data submission, completeness of data entry and internal validation.

In terms of surgeon outliers our view remains that it is insufficient to rely on individual clinicians alone to ensure there are no missing records, incomplete records or inaccurate data entry. Submitting data to NBSR is a combined responsibility of the Trust and all the clinicians involved in the multidisciplinary teams.

SUMMARY OF CLINICAL OUTCOMES

It is our policy that all mortalities related to bariatric surgery should be reported into the Registry, but we are not able to comment on any mortality that is not.

We use the same methodology as previous Consultant Outcome Reports in reporting in-hospital mortality rates. The definition of an “in-hospital death” used by NBSR is a death that occurs during the initial hospital stay before discharge. Although this mortality data potentially excludes patients who may be readmitted and die due to a complication of surgery within 30 days, the mortality statistics according to Hospital Episode Statistics (HES) records both the number of deaths in hospital and within 30 days of surgery. This HES data is shown below and demonstrates an extremely low mortality rate comparable to those seen in other countries (eg the American College of Surgeons Bariatric Surgery Center Network, where the published mortality rate was 0.12% for patients operated from 2007-10).

* As per HES policy in cases where there have been very small numbers recorded, the exact figures have been have been suppressed to prevent individual identification

Over the four year period a total of 6 in-hospital deaths were recorded by the NBSR database representing a mortality rate of 0.04% and no surgeon was noted to be a statistical outlier in terms of mortality rate.

Future reports may also include post-operative complications occurring within 30 days of the index procedure.

ACKNOWLEDGEMENT OF SUPPORTING TRUSTS

The NBSR committee would like to acknowledge voluntary financial contributions from Hospital Trust towards production of this report and maintenance of the NBSR.

CERTIFICATION

We believe the 4-year data for 2019-2023 are a correct representation from the Registry data of surgeon and hospital volume, baseline BMI, degree of baseline obesity-related disease, type of operation, in hospital mortality, and length of hospital stay.

On behalf of the NBSR Committee

Omar Khan (Chair), Ahmed Ahmed, Mohamed Aly, Andrew Currie, Matyas Fehervari, Helen Heneghan, Guy Holt, Naveed Hossain, Nadaya Isack, Kamal Mahawar, Emma McGlone, Alex Miras, Aruna Munasinghe, Aya Musbahi, Oliver Old, Chetan Parmar, Dimitri Pournaras, Christopher Pring, Andrew Robertson, Peter Small, Arutchelvam Vijayaraman, Peter Walton, Richard Welbourn