Endocrine Abstracts

Background: Nutritional deficiencies are frequently seen in bariatric patients, and typically become increasingly common and resistant following bariatric surgery. Local, national and international guidelines recommend routine blood tests and lifelong supplementation protocols after surgery. Local practice was initially audited for 2013. The purpose of this re-audit was to assess the impact of changes made in the department and to assess concordance with current recommendations.

Methods: Using electronic patient record systems and clinic letters, data were extracted for 137 patients who underwent gastric band, bypass and sleeve gastrectomy procedures in 2014. Data on pathology results, timings of samples and nutritional supplementation were recorded and compared to 2013 audit data.

Results: For bypass patients, a greater percentage of patients underwent postoperative monitoring blood tests at the 6 and 12 month time points relative to the initial audit, although once again the proportion of patients undergoing monitoring fell at each successive time point. More patients were discharged following surgery with Forceval multivitamin and a combined calcium and vitamin D supplement. Fewer patients were discharged with iron (26%). Despite the fact that fewer than 10% of bypass patients were receiving the recommended 3 monthly vitamin B12 injections in the first year after surgery, less than 10% of patients were found to be B12 deficient. Low Vitamin D was a common preoperative finding and for each of the three surgical procedures greater than 85% of patients were insufficient or deficient. In general, vitamin D deficiency became less common over time postoperatively, presumably due to increased surveillance and replacement in the early postoperative period. Monitoring of ferritin, folate, vitamin B12 and vitamin D was below 80% at all time points.

Conclusion: Whilst there have been increases in monitoring blood tests and provision of postoperative nutrient supplements after bariatric surgery, there is still room for improvement in compliance with local guidelines. A closer interaction between the bariatric service and Primary Care could support these vital elements of postoperative care and also allow more comprehensive audit and research in this area.