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Discussion

Bariatric surgery care pathways are widely regarded as varying considerably and international bariatric guidance is not specific with regard to the optimal model of care. 70 The results described in this chapter illustrate the large nationwide variability in preop and postop care, a likely consequence of widespread uncertainty regarding best practice and a lack of more detailed guidance with respect to service delivery. There is little evidence as to whether intensive preop and postop care improves outcomes and is cost-effective compared to less intensive care. This is likely to be more complicated than one standard pathway for all, with patient preferences also paramount in terms of type of provision (one-to-one or group sessions, for example). Furthermore, pre-surgery targets vary widely 95 but are often low-cost group interventions and funded from a separate budget to surgery. Maximum cost is around£ …