title: Experience of a specialist emergency bariatric surgical service.
abstract: BACKGROUND
  Bariatric surgery is associated with late and procedure-specific acute surgical complications. There is very little evidence available regarding the volume, nature, and outcomes of acute surgical admissions directly stemming from bariatric surgery. Centralization of bariatric elective services in the United Kingdom may have an adverse impact on the ability of local services to manage such unpredictable complications. To address this potential problem, we set up a comprehensive and specialist emergency bariatric service.
  
  
  OBJECTIVE
  The aim of this study was to quantify and characterize the workload of a specialist emergency surgical bariatric service.
  
  
  METHODS
  University National Health Service hospital.
  
  
  METHODS
  Over 2 years, we prospectively collected data on demographic characteristics, management, and outcomes of all acute surgical admissions related directly to previous bariatric surgery.
  
  
  RESULTS
  Between December 2011 and November 2013, 69 patients had 71 emergency admissions due to a surgical emergency directly related to previous bariatric surgery. Thirty-seven (54%) had undergone primary bariatric surgery at our institution, 13 (19%) at a different National Health Service hospital, 16 (23%) at private U.K. hospitals, and 3 (4%) at private overseas hospitals. Forty-four endoscopic or surgical interventions were required, of which 17 (39%) were performed on nights or weekends and within 12 hours of admission. Of 27 operations, 25 (93%) were completed laparoscopically. Median length of stay was 2 days, there were no mortalities, and there was 1 readmission within 30 days.
  
  
  CONCLUSIONS
  There is a significant volume of late bariatric surgical emergencies, many requiring urgent intervention. These may be effectively managed by a specialist bariatric service.
authors.affiliation: St. George's University Hospitals NHS Trust, London, United Kingdom.
authors.forename: Emma Rose
authors.initials: ER
authors.lastname: McGlone
authors.affiliation: St. George's University Hospitals NHS Trust, London, United Kingdom.
authors.forename: Alexandrina
authors.initials: A
authors.lastname: Roman
authors.affiliation: St. George's University Hospitals NHS Trust, London, United Kingdom.
authors.forename: Ajit
authors.initials: A
authors.lastname: Kayal
authors.affiliation: St. George's University Hospitals NHS Trust, London, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Reddy
authors.affiliation: St. George's University Hospitals NHS Trust, London, United Kingdom. Electronic address: omar.khan7000@gmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Khan
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013222:State Medicine / Q000706:statistics & numerical data; D006113:United Kingdom; D016526:Workload / Q000706:statistics & numerical data
keywords: Bariatric surgery; Emergency services; Minimal access surgical procedures; Specialization