Introduction: Ten percent of cirrhotic patients are known to have a high risk of postoperative complications. Ninety percent of bariatric patients suffer from non-alcoholic fatty liver disease (NAFLD), and 50% of them may develop non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis. The aim of this study was to assess whether the presence of cirrhosis at the time of bariatric surgery is associated with an increased rate and severity of short- and long-term cirrhotic complications. Methods: A cohort of 110 bariatric patients, between May 2003 and February 2018, who had undergone liver biopsy at the time of bariatric surgery were reassessed for histological outcome and divided into two groups based on the presence (C, n = 26) or absence (NC, n = 84) of cirrhosis. The NC group consisted of NASH (n = 49), NAFLD (n = 24) and non-NAFLD (n = 11) liver histology. Medical notes were retrospectively assessed for patient characteristics, development of 30-day postoperative complications, severity of complications (Clavien-Dindo (CD) classification) and length of stay. The C group was further assessed for long-term cirrhosis-related outcomes. Results: The C group was older (52 years vs 43 years) and had lower BMI (46 kg/m² vs 52 kg/m²) and weight (126 kg vs 145 kg) compared to the NC group (p < 0.05). The C group had significantly higher overall complication rate (10/26 vs 14/84, p < 0.05) and severity of complications (CD class ≥ III, 12% vs 7%, p < 0.05) when compared to the NC group. The length of stay was similar between the two groups (5 days vs 4 days). The C group had significant improvement in model end-stage liver disease scores (7 vs 6, p < 0.01) with median follow-up of 4.5 years (range 2–11 years). There were no long-term cirrhosis-related complications or mortality in our studied cohort (0/26). Conclusion: Bariatric surgery in cirrhotic patients has a higher risk of immediate postoperative complications. Long-term cirrhosis-related complications or mortality was not increased in this small cohort. Preoperative identification of liver cirrhosis may be useful for risk stratification, optimisation and informed consent. Bariatric surgery in well-compensated cirrhotic patients may be used as an aid to improve long-term outcome.

Background Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery. Materials and Methods Between 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Results Patient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05). Conclusion Endobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.

Bariatric multidisciplinary team (MDT) meetings are critical for the coordination of complex patient care, however, delay in documenting outcomes on electronic patient records (EPRs) can slow clinical decision making and patient management. Both the British Obesity and Metabolic Surgery Society and the General Medical Council recommend prompt documentation and sharing of MDT decisions with relevant healthcare professionals. Timely MDT documentation is recognized as important across specialties, but there is limited evidence on effective strategies to improve documentation timeliness specifically in bariatric services, where case complexity is increasing with newer therapies. This project aimed to improve the completeness and timeliness of bariatric MDT outcome documentation on the EPR by introducing live documentation during meetings. We conducted a quality improvement project at a district general hospital bariatric centre. The baseline audit (January 2023–December 2024) recorded documentation practices for 1498 patients. Following team consultation, we implemented live documentation during MDT meetings. The post-intervention audit (January–May 2025) evaluated 294 patients. We measured documentation completeness, same-day recording rates among patients who had an EPR outcome recorded, and time delays. Because documentation delay data were highly skewed, the primary comparison of delay used the Mann–Whitney U test, with median and interquartile range reported as the principal descriptive statistics. Chi-square test was used for categorical variables. Absolute risk differences with 95% confidence intervals were calculated using the Wald method for two independent proportions. Statistical analysis was performed using SPSS version 28. Before intervention, 228/1498 patients (15.2%) had no MDT outcome documented on the EPR. Among the 1270 patients with documentation, 106 (8.3%) had same-day entries; the median delay was 7 days (IQR 5–40). Post-intervention, only 5/294 patients (1.7%) lacked an EPR report. Among the 289 patients with documentation, 121 (41.9%) had same-day entries; the median delay fell to 1 day (IQR 0–4). The reduction in documentation delay was statistically significant (Mann–Whitney U test, P < .001). The proportion of patients without documentation decreased by an absolute 13.5% (95% CI −15.9% to −11.2%; P < .001). Same-day documentation among those with a recorded outcome increased by an absolute 33.6% (95% CI +27.6% to +39.4%; P < .001). Live documentation during bariatric MDT meetings was associated with improved completeness and timeliness of EPR entries. This simple initiative may improve timely access to MDT decisions for professionals coordinating care and offers a potentially transferable approach for other specialities managing complex conditions, particularly as bariatric care evolves with new technologies and therapies.

Introduction: Morbid obesity has serious associated co morbidities and is an independent risk factor for ischaemic heart disease. Obesity together with low functional status and exercise tolerance makes pre-operative cardiac assessment difficult and patients with few cardiac risk factors are often referred for cardiac assessment. This can not only be burdensome to services and prolongs waiting times for surgery but can also cause patient anxiety and poor compliance. Background: The revised cardiac risk index (RCRI) is a validated risk stratification tool for predicting the risk of major cardiac events in the non-cardiac surgical setting. Multiple factors like type of surgery, history of ischaemic heart disease, history of congestive heart failure, history of cerebrovascular disease,preoperative treatment with insulin and preoperative serum creatinine (>2 mg/dl) stratify individuals into four categories (I, II, III and IV), the risk of cardiac events increases with each category (0.4, 0.9. 6.6, and 11% respectively). Aim: The aim of this study is to assess whether the number of referrals to cardiology could be reduced by applying RCRI, yet still capture all of the pre-operative cardiac therapeutic interventions. We also studied the impact of cardiology referral on waiting times, development of cardiac complication whilst awaiting surgery and associated symptomatology of patients requiring cardiac intervention. Methods: Between 2005 and 2014, a cohort of 1040 patients that had been evaluated for weight loss surgery was identified. Retrospective analysis of the clinical records was undertaken. Referrals to cardiology at this time were based on clinical judgement. Data collected included: RCRI, referral to cardiology, symptomatology, cardiac investigations and interventions, waiting time, morbidity and mortality. Results: Out of 1040 patients, 868 patients were not referred to cardiology and did not require any cardiac intervention (0.0%). 172 (16%) were referred to cardiology, nine of the 172 patients (5%) required cardiac intervention; of which, six patients (20%) belonged to RCRI category III and IV (n=30) compared to three patients (2%) in category I and II (n=142), making patients in category III and IV significantly more likely to receive cardiac intervention (P<0.01). Waiting time for surgery was significantly higher in cardiology referral group (Median: 240 days) compared to non-cardiology group (Median: 0 days, P<0.01). Four patients (2%) in cardiology referral group developed myocardial Infarction whilst waiting for review (including 1 death=0.5%), which was significantly higher than those not referred to cardiology (n=0, P<0.01). Of all the patients requiring cardiac intervention (n=9), chest pain (alone or in combination with previous cardiac history or SOB) was the strongest associated symptom requiring cardiac intervention (n=8, P<0.01). This together with RCRI III and IV consisted of positive predictive value of 66.66% in this studied population. Conclusions: Cardiology referrals significantly increase waiting time. Cardiac interventions are more likely in patients with RCRI III and IV. Application of RCRI together with symptom of chest pain can make a good risk stratification tool for cardiac assessment in bariatric patients. Limiting cardiology referrals predominantly to this group would substantially reduce waiting time, cardiac referrals and development of complications as a result.