Five years after bariatric surgery, the majority of patients have not seen their surgeon and no longer take their vitamins.
- More than 42,000 obese people underwent bariatric surgery in 2013. This is three times more than in 2009.
- By 2017, some 500,000 patients will have been operated.
- Current techniques require lifelong monitoring, linked to changes in the digestive system. But the consultations go from 90% to 12%.
- In addition to monitoring, vitamin and essential element supplements are prescribed. Only 6% of patients take them on a regular basis.
Obesity is exploding in France. 15% of the population is severely overweight. And by 2017, half a million people will have undergone bariatric surgery. A rapid growth for this intervention authorized since 2009. The solution remains no less radical, since it supposes to completely remodel the digestive system.
Long-term follow-up is therefore indicated, but poorly followed. Over five years, the lack of seriousness of patients reached an unprecedented scale. Health insurance data confirms this, in a study presented at the French Congress of Surgery (Porte Maillot, Paris, September 28-30).
12% of appointments honored
“The follow-up after bariatric surgery is really essential”, insists Jérémie Théreaux, bariatric surgeon at the University Hospital of Brest (Finistère). The study that the doctor coordinated covers all of the patients operated on in 2009, ie 16,000 people.
Official recommendations require, in fact, to consult a specialist once a year, whether surgeon or endocrinologist. But this rule is rarely followed. The fifth year following the intervention, 12% honored their annual appointment.
A very poor score when you know that on the first anniversary of the surgery, 90% of them see their surgeon again. “People are in pain, need to watch out for scars, and have marked weight loss. They are very motivated, ”explains Dr Théreaux. The results, already not very bright during the year, are even darker for the appointments with the endocrinologist: only 3% are carried out.
The deadlock on supplements
This lack of follow-up has concrete consequences on the health of those operated on. After a bypass or sleeve gastrectomy (sleeve), vitamins and trace elements are prescribed. Surgery modifies their absorption, so this supplementation is necessary, even vital.
“Some deficiencies can be serious and endanger the life of the patient,” emphasizes Jérémie Théreaux. Patients are obviously not aware of it: 97% do not take calcium, 93% ignore iron and 90% on vitamin D.
The alert does not end there: these figures relate to people who have not received a single refund. “Theoretically, the cachet is taken daily. A single reimbursement is therefore a far cry from a treatment taken every day, ”notes Dr Théreaux.
Whose fault is it ? Certainly not in the amount of the support, since the community pays for the prescribed supplements. The lack of follow-up and information of the operated on is undoubtedly in question.
Simon Msika, surgeon at Louis-Mourier hospital (Colombes): ” It is the follow-up that makes it possible to increase compliance with the vitamins. Spontaneously, patients give up. “
Simon Msika, bariatric surgeon at Louis-Mourier hospital (Colombes, Hauts-de-Seine) believes that, if the survey were repeated over the following generations, the results would be more positive. “People know they need to take vitamins,” he says. It is true that the multidisciplinary teams have perfected their approach over the years.
The general practitioner in rescue?
But patients are also responsible for this poor record, because they do not go to annual appointments. The factors are multiple: youth, the absence or disappearance of associated diseases, spectacular weight loss but also the events of daily life – a move for example. And then, over time, recklessness takes over.
But the outcome is almost systematic for these patients lost to follow-up. “The percentage of failure is high because the diet slips, just like the psychological care”, deplores Simon Msika. Because the operation can weaken the mind of the patient.
The solution to this thorny problem could come from general practitioners. In the hospital, the follow-up is clearly insufficient. On the other hand, 71% of the operated on see their general practitioner. On average six times a year.
Good news in the eyes of Dr Msika. “We had the impression that people came back to see us without going to their doctor. It was wrong, ”he rejoices. All the more so as with time, the knowledge of general practitioners on bariatric surgery has progressed, thanks to various means of information.
Simon msika : ” Bariatric surgery was considered very specialized. In fact, GPs have started to learn. “
Additional relays
Health Insurance is visibly aware of this development: in its 2015 “Charges and income” report, it suggests that general practitioners act as relays for specialist teams. “We will have to rely on treating physicians, who create a national network, to try to put patients back in the circuit or to prescribe them the biological assessments and the necessary supplements”, confirms Jérémie Théreaux. Because with more and more patients, the task may be too heavy for the only specialized establishments.
But GPs themselves risk being quickly overwhelmed. The “shifting of tasks” towards trained nurses could act as a relay. They would only send adrift patients to a doctor. “It’s a good idea but the implementation remains difficult,” concedes Simon Msika, however. It is indeed necessary to frame the exercise, to remunerate it and to set up the training of the relays. More restrictive solutions can therefore be imagined, and there are many: care contract in the preoperative phase, financial constraints, etc.
Simon msika : ” We talk about all the possibilities: financial constraints on the part of health insurance funds. But penalizing patients is not on his mind. “
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