What is the effect of bariatric surgery on health-related quality of life in people with obesity? observational cohort analysis of the United Kingdom national bariatric surgery registry

John Buckell; Peter K Small; Susan A Jebb; Paul Aveyard; Omar Khan; Emma Rose McGlone; NBSR Collaborators

doi:10.1097/JS9.0000000000002044

What is the effect of bariatric surgery on health-related quality of life in people with obesity? observational cohort analysis of the United Kingdom national bariatric surgery registry

Int J Surg. 2024 Aug 22;110(11):6898-6905. doi: 10.1097/JS9.0000000000002044. Online ahead of print.

Authors

John Buckell¹, Peter K Small², Susan A Jebb³, Paul Aveyard³, Omar Khan⁴, Emma Rose McGlone⁵; NBSR Collaborators

Affiliations

¹ Health Economics Research Centre, Oxford Population Health, University of Oxford.
² Department of bariatric and upper gastro-intestinal surgery, Sunderland NHS Foundation Trust.
³ Nuffield Department of Primary Health Care Sciences, University of Oxford.
⁴ Department of bariatric and upper gastro-intestinal surgery, St George's University Hospitals NHS Foundation Trust.
⁵ Department of Surgery and Cancer, Imperial College London Faculty of Medicine, 7th floor Commonwealth Building, Du Cane Road, London W12 0NN.

Abstract

Background: Previous small studies investigating health-related quality of life (HRQoL) following bariatric surgery have demonstrated heterogenous effects. This study aimed to use National Bariatric Surgery Registry (NBSR) records to investigate the relationship between weight and HRQoL in people undergoing bariatric surgery in the UK.

Materials and methods: In this observational study using United Kingdom National Bariatric Surgery Registry (NBSR) records between 1st June 2017 and 23rd November 2022, patients undergoing primary bariatric surgery with one baseline and at least one follow-up visit within one year from surgery were eligible for inclusion. Models estimated the relationship between EuroQol Five Dimension 5-level (EQ-5D) and BMI at baseline and longitudinally. Further analyses stratified by type 2 diabetes, type of operation (adjustable gastric band, sleeve, or bypass) and domain of EQ-5D.

Results: 5,587 observations of 2,160 patients were analysed. At baseline, mean BMI was 45.7±7.8 kg/m2 and mean EQ-5D was 0.78±0.22. A 1 kg/m2 higher BMI was associated with 0.005 (95%CI[-0.006,-0.004]) lower EQ-5D. In the month following surgery, EQ-5D increased to 0.91±0.2 while BMI decreased to 39.8±7.1 kg/m2 (P<0.001 for both); subsequently EQ-5D plateaued (0.90±0.17 at 12 months) while BMI continued to decrease (31.5±6.2 kg/m2 at 12 months, P<0.001). Each 1 kg/m2 decrease in BMI was associated with a 0.006 (95%CI [-0.007,-0.005]) increase in EQ-5D. Remission of T2D was independently associated with increase in EQ-5D (0.037, 95%CI [0.015,0.059]); type of operation was not. Decreases in BMI were associated with improvements in all five domains of EQ-5D.

Conclusions: In this large dataset, greater weight loss and T2D remission were independently associated with greater improvements in HRQoL following bariatric surgery. The HRQoL-BMI relationship for people undergoing bariatric surgery differs to that which has previously been estimated following behavioural interventions. Use of the estimates generated here will be important for clinical and political decision making.