Unplanned interventions following bariatric surgery: first cohort outcomes from the National Emergency Bariatric Surgery Audit (NEBSA)

BACKGROUND: Despite the increasing volume of bariatric surgery, patterns of management following complications are poorly characterized in national datasets. We present the UK data collected by the National Emergency Bariatric Surgery Audit on patient characteristics following treatment for bariatric surgery complications, concentrating on 30-day mortality, complication severity, threshold for intensive care unit (ITU)/ high dependency unit (HDU) care, and postoperative follow-up. These data seek to inform the design of new clinical studies, support service development, and address surgical training requirements.

METHODS: A prospective, multi-center audit was conducted across UK hospitals from October 2023 to March 2025. Adults presenting with bariatric surgery-related complications requiring urgent intervention were included. Demographics, index procedures, presentation details, and outcomes were collected using a standardized electronic tool.

RESULTS: A total of 187 patients were included. The median age was 43 years, and 85.6% were female. The most common index procedures were sleeve gastrectomy (25.7%) and Roux-en-Y gastric bypass (31%). A total of 34.8% of patients had undergone surgery abroad. Emergency department attendance accounted for 72.2% of presentations. Emergency surgery was needed in 86.1% of cases, with two recorded deaths (0.8%). Additionally, 14% of patients were admitted to ITU. Follow-up was arranged for 73.3% of patients. Variation was noted in follow-up plans and the threshold for ITU/HDU care.

CONCLUSION: Emergency bariatric surgery is a distinct and growing domain within acute surgical practice. This study highlights the urgent need for standardization of treatment pathways, targeted investment, training, and national collaboration to improve outcomes in the emergency treatment of bariatric complications. The data from this cohort can provide a stepping stone to better understanding the service, training, research, and funding needs of complex bariatric emergency services.