‘The rollercoaster of follow‐up care’ after bariatric surgery: a rapid review and qualitative synthesis

Abstract

Summary Benefits of bariatric surgery for obesity related comorbidities are well established. However, in the longer term, patients can become vulnerable to procedure specific problems, experience weight regain and continue to need monitoring and management of comorbidities. Effective longer term follow‐up is vital due to these complex needs post‐surgery. Current guidance recommends annual long‐term follow‐up after bariatric surgery. However, attendance can be low, and failure to attend is associated with poorer outcomes. Understanding patients' experiences and needs is central to the delivery of effective care. This rapid review has synthesized the current qualitative literature on patient experiences of healthcare professional (HCP) led follow‐up from 12 months after bariatric surgery. A recurring theme was the need for more and extended follow‐up care, particularly psychological support. Enablers to attending follow‐up care were patient self‐efficacy as well as HCP factors such as a non‐judgemental attitude, knowledge and continuity of care. Barriers included unrealistic patient expectations and perceived lack of HCP expertise. Some preferences were expressed including patient initiated access to HCPs and more information preoperatively to prepare for potential post‐surgery issues. Insights gained from this work will help identify areas for improvement to care in order to optimize longer term outcomes.

Patients’ experiences of life after bariatric surgery and follow-up care: a qualitative study

“…Some show certain aspects of HRQL to improve but not others 11 12 18. Previous qualitative research has highlighted the complex and changeable nature of the psychosocial impact of bariatric surgery, helping to shed light on some of these inconsistencies in the HRQL literature and emphasising the importance of long-term postoperative support in helping patients manage these changes 10 19. Previous research has also reported attendance at follow-up visits to be associated with better weight loss outcomes after bariatric surgery 20.…”

“…Qualitative research is useful to explore patients’ perspectives as it seeks to gain the insider’s view on how people view, experience and make sense of their social world 25–27. The primary focus of most previous qualitative research in bariatric surgery has been on patient experiences of outcomes of surgery rather than experiences of follow-up care 10 19. Studies that have reported on aspects of care have identified patient need for longer follow-up after bariatric surgery, better access to psychological support and the ability to communicate with health professionals between routine appointments 19 28–36.…”

“…The primary focus of most previous qualitative research in bariatric surgery has been on patient experiences of outcomes of surgery rather than experiences of follow-up care 10 19. Studies that have reported on aspects of care have identified patient need for longer follow-up after bariatric surgery, better access to psychological support and the ability to communicate with health professionals between routine appointments 19 28–36. However, most of these studies were single centre29–32 34 36 or reported findings from select groups, such as patients that had undergone one type of bariatric procedure only (eg, AGB)29 30 32–35 or had experienced negative outcomes such as weight regain or substance abuse issues 28 29 32 34.…”

“…However, most of these studies were single centre29–32 34 36 or reported findings from select groups, such as patients that had undergone one type of bariatric procedure only (eg, AGB)29 30 32–35 or had experienced negative outcomes such as weight regain or substance abuse issues 28 29 32 34. A recent systematic review by Parretti et al identified few studies focusing on patients’ experiences of follow-up care after bariatric surgery in the longer term, and recommended that primary studies in this area were needed 19. The objectives of this study were to: (1) Investigate experiences of life after bariatric surgery including follow-up care in the long-term across people who had undergone all three main types of UK bariatric procedures and (2) Use these findings to provide recommendations for follow-up care.…”

Yonder: Traumatic brain injury, lung cancer, bariatric surgery, and screen time

“…A recent UK study synthesised the available published literature on patient experiences on clinician follow-up from 12 months after bariatric surgery. 3 They found a clear need for improved nutritional and psychological support. Patients were more likely to engage if clinicians had nonjudgemental attitudes, were knowledgeable, and were able to offer continuity of care.…”