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. 2021 Jun;31(6):2529-2536.
doi: 10.1007/s11695-021-05303-2. Epub 2021 Mar 16.

The Effect of Participation in Tier 3 Services on the Uptake of Bariatric Surgery

Chanpreet Arhi  1 , Chrysanthi Karagianni  1 , Louise Howse  1 , Midhat Siddiqui  1 , Cynthia-Michelle Borg  2
Affiliations

The Effect of Participation in Tier 3 Services on the Uptake of Bariatric Surgery

Chanpreet Arhi et al. Obes Surg. 2021 Jun.

Abstract

Background: Despite the recognised advantages of bariatric and metabolic surgery, only a small proportion of patients receive this intervention. In the UK, weight management systems are divided into four tiers. Tier 3 is a clinician-lead weight loss service while tier 4 considers surgery. While there is little evidence that tier 3 has any long-term benefits for weight loss, this study aims to determine whether tier 3 improves the uptake of surgery.

Method: A retrospective cohort study of all referrals to our unit between 2013 and 2016 was categorised according to source-tier 3, directly from the general practitioner (GP) or from another speciality. The likelihood of surgery was calculated using a regression model after considering patient demographics, comorbidities and distance from our hospital.

Results: Of the 399 patients, 69.2% were referred directly from the GP, 21.3% from tier 3, and 9.5% from another speciality of which 69.4%, 56.2%, and 36.8% progressed to surgery (p = 0.01). On regression analysis, patients from another speciality or GP were more likely to decide against surgery (OR 2.44 CI 1.13-6.80 p = 0.03 and OR 1.65 CI 1.10-3.12 p = 0.04 respectively) and more likely to be deemed not suitable for surgery by the MDT (OR 6.42 CI 1.25-33.1 p = 0.02 and OR 3.47 CI 1.11-12.9 p = 0.03) compared with tier 3 referrals.

Conclusion: As patients from tier 3 were more likely to undergo bariatric and metabolic surgery, this intervention remains a relevant step in the pathway. Such patients are likely to be better informed about the benefits of surgery and risks of severe obesity.

Keywords: Surgery; Tier 3; Weight management services.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing the numbers excluded. Percentages of original 484 patients
See this image and copyright information in PMC

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