Patients dying on waiting list for bariatric surgery

By June Shannon Obesity News   |   7th Sep 2018

The average waiting time for bariatric surgery was 3.3 years with some patients waiting for up to six years.

Nine young patients with obesity died on the waiting list for bariatric or weight loss surgery in Ireland in the past five years and more than half have developed a new obesity related illness while on the list, a new study has found.

According to data due to be presented at the Sir Peter Freyer Surgical meeting in NUI Galway today (Friday 07 September) by Ms Helen Heneghan, Consultant Bariatric Surgeon at St Vincent’s University Hospital and St Columcille’s Hospital in Dublin, nine patients have died in the last five years while waiting for bariatric surgery in Ireland and others have developed increased complications and illnesses as a result of obesity while awaiting surgery.

Speaking to the Irish Heart Foundation, Ms Heneghan explained that over the past 12 months she and the multidisciplinary bariatric team reassessed 130 patients who were on the waiting list for bariatric surgery at the National Centre for Bariatric Surgery in St Vincent’s University Hospital in Dublin.

“It is extremely concerning that 9 patients have died in the last four or five years who had been listed for bariatric surgery. If that happened on any other waiting list there would be national outrage,” she said.

“It is extremely concerning that 9 patients have died in the last four or five years who had been listed for bariatric surgery. If that happened on any other waiting list there would be national outrage,”

Ms Helen Heneghan, Consultant Bariatric Surgeon , St Vincent’s University Hospital Dublin

Some of the patients who died were in their late 30s while the others were in their 40s and early 50s.

So, these are tragic deaths, Ms Heneghan said.

According to Ms Heneghan, while it may be argued that these patients died because of their obesity-related conditions, she said that in her opinion some of these deaths were preventable.

“I think some would have been preventable if these people had surgery sooner. You could argue they may have died anyway, even after surgery, they died of obesity complications that an operation could have been too late at that stage to reverse. But we know from large international studies that bariatric surgery lengthens lives for this exact reason. There is a lower incidence of heart disease. The risk of getting an MI or a stroke can be lowered by as much as 40 per cent after bariatric surgery compared to obese people who don’t have it, so we are missing an opportunity to intervene here and save lives.”

"We are missing an opportunity to intervene here and save lives,”

Ms Helen Heneghan, Consultant Bariatric Surgeon, St Vincent's University Hospital, Dublin

The study also found that the average waiting time for bariatric surgery was 3.3 years while some patients had been waiting for up to six years.

The review further revealed that more than half, or 51 per cent of people on the waiting list had developed a new health problem in the time they were waiting for surgery which meant they had to be re-evaluated.

Ms Heneghan said it meant the service was spending more time and resources revaluating patients and getting extra tests done when they would have been deemed fit for surgery at the time they were first listed.

The main health difficulties patients had developed while on the list included sleep disorders, such as obstructive sleep apnoea and cardiovascular disease.

According to the findings, in the time they have been waiting for surgery 13 per cent of patients had developed cardiac disease which included a heart attack, significant angina requiring stents, or heart failure.

“We have missed an opportunity to intervene and lower their risk rather than allow young patients develop these events. I think it is a really frightening that we have let this happen,” Ms Heneghan said

The consultant bariatric surgeon explained that weight loss surgery was cost-saving within a few months. For example, up to 90 per cent of patients with diabetes can be taken off most of their diabetes medication post-surgery and are no longer at risk of developing many of the complication of diabetes.

Up to 70 per cent see an improvement or even remission of high blood pressure and surgery can also improve cholesterol levels within months.

“It’s depressing and demoralising to read these findings,"

Professor Donal O Shea, , HSE Clinical Lead Obesity

“Their cardiovascular risk improves by about 40 per cent and that is within three to six months of surgery. They don’t even have to have lost all the weight as the effects of surgery go way beyond losing weight,” Ms Heneghan explained.

In the past 12 months the service at SVUH has operated on 84 of the 130 patients in the review and there are plans to operate on the remaining patients in the coming months.

However, Ms Heneghan said if there was no dedicated funding available for the service next year then there was a real danger that it may have to close.

“We haven’t been given dedicated funding at all yet to do this. If we don’t get if for next year we are going to have to stop the service and that’s shameful if the government allowed that to happen, knowing what is happening to these people on a waiting list,” Ms Heneghan stated.

Commenting, Professor Donal O Shea, HSE Clinical Lead for Obesity said, “The lack of access to bariatric surgery in Ireland has definitely contributed to these deaths.”

“It’s depressing and demoralising to read these findings. The Obesity Policy and Action Plan was launched almost two years ago with a clear stated plan to get this life saving (and cost saving) surgery up and running. That still hasn’t happened – but the HSE has a strong bid in for next year’s budget estimates to firmly establish 2 surgical units in Ireland. Myself and Francis Finucane – who leads the obesity unit in Galway – have had positive meetings with Minister Harris, Department of Health Officials (earlier this week) and the Department of Finance earlier in the year. The desire to provide a service is there when we talk to people and the NTPF have recently given some funds to increase surgery in Ireland East. If formal funding doesn’t happen this year I will be beyond disappointed. This new data from Helen Heneghan should be the last time we need to read about the complete lack of access to obesity surgery.”

"It’s a shocking indictment of a society that hasn’t done enough to protect its citizens, its children from the causes of obesity and is even failing to protect those whose lives are on the line,”

Janis Morrissey, Head of Health Promotion, Information and Training, Irish Heart Foundation

Janis Morrissey, Head of Health Promotion, Information and Training with the Irish Heart Foundation, said it was important that this study’s findings be viewed within a broader response to obesity.

“The first line is of course prevention, in terms of changing the environment we live in to promote a healthy weight. Bariatric surgery is a last resort, and a decision made by the individual and their medical team, usually following years of attempted struggles with weight management for individuals who are clinically obese. For those individuals we know bariatric surgery is very effective and it should be available in a timely manner for those who need it to ensure their health and overall quality of life are not unnecessarily compromised.”

It’s a shocking indictment of a society that hasn’t done enough to protect its citizens, its children from the causes of obesity and is even failing to protect those whose lives are on the line,” she added.

‘The Clinical Impact of Delaying Access to Bariatric Surgery in Ireland,’ was due to be presented at the 2018 Sir Peter Fryer Surgical Symposium which takes place in NUI Galway on Friday 07 and Saturday 08 September.

 

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