Quality standard

Quality statement 6: Follow-up care after bariatric surgery

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Patient satisfaction with bariatric surgery.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

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 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).

People who have had an operation to help them lose weight (called bariatric surgery) have follow-up care from 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

Obesity: identification, assessment and management. NICE guideline CG189 (2014, updated 2023), recommendation 1.11.1

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.

[NICE's guideline on obesity: identification, assessment and management, recommendation 1.11.1]

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. [NICE's full guideline on obesity: identification, assessment and management, section 9.1.3.2]