Urgent consultation, action, and legislation is required to address overseas cosmetic and bariatric tourism
Dear Editor,
We were pleased to read the article highlighting the ongoing issue of complications from overseas bariatric surgery, particularly the gap in the delivery of aftercare (1).
Our department has seen several patients with emergency complications associated with cosmetic tourism in the past year.
Most patients presenting with complications from overseas cosmetic surgery require admission for one or more of surgery, drainage of collections, and intravenous antibiotics. Radiological imaging is frequently required to characterise collections or during ultrasound-guided drainage. Rarely, patients may require further washouts or revision surgery. Patients may require outpatient follow-up over several months. When patients do not present immediately, they may suffer without appropriate follow-up.
It is difficult to know the number of people undergoing these types of surgery who return to the UK without immediate complications, data which are important for accurate cost analysis, but it is clear the burden on NHS services can be extremely high, and complications from surgery can be life-altering or threatening.
Aside from the disproportionate use of emergency resources when compared with elective surgery, managing complications from overseas cosmetic and bariatric surgery comes with logistical and technical difficulties, such as the difficulty in accessing operative documentation. A rise in the use of emergency operative time stretches the burden on the NHS by increasing the emergency theatre workload. Radiological imaging, inpatient stay, and outpatient wound care can carry considerable costs.
Unsurprisingly, the most common reasons for seeking cosmetic tourism are an inability to access care on the NHS and the inability to afford private alternatives in the UK (2).
Further education and legislation are required to protect patients who seek healthcare abroad and safeguard valuable NHS resources. Significant efforts to reduce waiting lists may discourage patients who can access these procedures on the NHS. A review of the criteria for eligibility for these procedures could be considered. Government-backed and widely broadcast education campaigns will raise awareness. Advice and support should be available to those continuing to seek surgery abroad. Nationwide data collection will aid in accurate cost analysis.
We urge health policymakers to engage in consultation with bariatric and cosmetic surgeons, health economists, patients, and insurance providers to develop pragmatic and safe solutions to managing and funding the provision of post-operative and emergency care for patients who undergo cosmetic and bariatric surgery abroad.
References:
1. Mahase E. Weight loss surgery: Patients need clearer warnings of risks from overseas care, say doctors BMJ 2024; 384 :q583 doi:10.1136/bmj.q583
2. Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M. Complications of Cosmetic Surgery Abroad - Cost Analysis and Patient Perception. Plast Reconstr Surg Glob Open. 2019 Jun 12;7(6):e2281. doi: 10.1097/GOX.0000000000002281. PMID: 31624684; PMCID: PMC6635218.
Competing interests:
No competing interests
27 March 2024
Daniel J Chivers
Foundation Year 2 Doctor
William Watkinson, Plastic Surgery Registrar, Sheffield Teaching Hospitals NHS Foundation Trust, Humairaa Asmal, Medical Student, University of Sheffield Medical School, Joseph Stallard, Consultant Hand and Plastic Surgeon, Sheffield Teaching Hospitals NHS Foundation Trust
Rapid Response:
Urgent consultation, action, and legislation is required to address overseas cosmetic and bariatric tourism
Dear Editor,
We were pleased to read the article highlighting the ongoing issue of complications from overseas bariatric surgery, particularly the gap in the delivery of aftercare (1).
Our department has seen several patients with emergency complications associated with cosmetic tourism in the past year.
Most patients presenting with complications from overseas cosmetic surgery require admission for one or more of surgery, drainage of collections, and intravenous antibiotics. Radiological imaging is frequently required to characterise collections or during ultrasound-guided drainage. Rarely, patients may require further washouts or revision surgery. Patients may require outpatient follow-up over several months. When patients do not present immediately, they may suffer without appropriate follow-up.
It is difficult to know the number of people undergoing these types of surgery who return to the UK without immediate complications, data which are important for accurate cost analysis, but it is clear the burden on NHS services can be extremely high, and complications from surgery can be life-altering or threatening.
Aside from the disproportionate use of emergency resources when compared with elective surgery, managing complications from overseas cosmetic and bariatric surgery comes with logistical and technical difficulties, such as the difficulty in accessing operative documentation. A rise in the use of emergency operative time stretches the burden on the NHS by increasing the emergency theatre workload. Radiological imaging, inpatient stay, and outpatient wound care can carry considerable costs.
Unsurprisingly, the most common reasons for seeking cosmetic tourism are an inability to access care on the NHS and the inability to afford private alternatives in the UK (2).
Further education and legislation are required to protect patients who seek healthcare abroad and safeguard valuable NHS resources. Significant efforts to reduce waiting lists may discourage patients who can access these procedures on the NHS. A review of the criteria for eligibility for these procedures could be considered. Government-backed and widely broadcast education campaigns will raise awareness. Advice and support should be available to those continuing to seek surgery abroad. Nationwide data collection will aid in accurate cost analysis.
We urge health policymakers to engage in consultation with bariatric and cosmetic surgeons, health economists, patients, and insurance providers to develop pragmatic and safe solutions to managing and funding the provision of post-operative and emergency care for patients who undergo cosmetic and bariatric surgery abroad.
References:
1. Mahase E. Weight loss surgery: Patients need clearer warnings of risks from overseas care, say doctors BMJ 2024; 384 :q583 doi:10.1136/bmj.q583
2. Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M. Complications of Cosmetic Surgery Abroad - Cost Analysis and Patient Perception. Plast Reconstr Surg Glob Open. 2019 Jun 12;7(6):e2281. doi: 10.1097/GOX.0000000000002281. PMID: 31624684; PMCID: PMC6635218.
Competing interests: No competing interests