Post-operative complications of medical tourism represent a growing financial burden on the NHS

Post-operative complications of medical tourism represent a growing financial burden on the NHS

The post-operative complications of medical tourism could cost the NHS up to £20,000 per patient, according to the results of a rapid review of available data published in the open access journalBMJ open.

However, data on use, frequency and consequences for the NHS is incomplete and arbitrary, making it currently impossible to fully understand the risks of surgery abroad, researchers warn.

The number of medical tourists has risen steadily over the past few decades, a trend that shows no signs of abating, the researchers note. And management of any postoperative complications is usually the responsibility of the home health service and can be further complicated by inadequate information about the initial surgery, they add.

Given the lack of systematically collected data, the researchers wanted to estimate the costs and savings to the NHS from medical tourism, as well as the nature, frequency and associated complications, as well as any subsequent treatment, care and use of NHS resources.

They searched research databases for relevant studies as well as "gray literature" such as conference proceedings, discussion papers, editorials, and government, industry and institutional reports published between 2012 and December 2024.

Studies that described cases of emergencies and urgent operations abroad; treatment of cancer, infertility and dentistry; and transplant surgeries were excluded from analysis.

A total of 90 full-text articles were selected for review, of which 38 reports describing 37 studies were eligible for inclusion: 19 described complications due to metabolic/bariatric surgery; 17 complications due to cosmetic surgery; and a complication from eye surgery.

The case series and case reports included 655 patients treated on the NHS between 2011 and 2024 for complications related to metabolic/bariatric (385), cosmetic (265) or ophthalmic surgical (5) tourism.

23 studies reported on the target country. A total of 29 countries were reported from all continents, with Turkey being the most common destination (61%). Most patients were women (90%), and the mean age was 38 years, but the range was 14 to 69 years.

The most commonly reported procedures were sleeve gastrectomy - the removal of part of the stomach to create a smaller "sleeve" - ​​breast augmentation and "tummy tuck" (tummy tuck).

Twenty-two studies (371 patients) reported some details on complications. No deaths were reported in the included studies, but at least 196 patients (53%) experienced moderate to severe complications.

However, most studies did not clearly report the treatment of these conditions and only 14 studies reported the associated costs, which ranged from £1,058 to £19,549 per patient at 2024 prices.

Eight studies (159 patients) reported length of hospital stay for treatment of metabolic/bariatric surgical tourism complications. The combined average length of stay was just over 17 days; the longest lasted 45 days.

The combined average length of stay for treatment of cosmetic complications was almost 6 days; the longest lasted 49 days. Over 50 outpatient appointments and 4 surgical procedures were reported for eye surgery tourism.

Very few studies reported the use of other resources, such as: B. day clinic procedures, operation time, clinic appointments or number and type of diagnostic tests.

The certainty of the evidence obtained from most studies was low, mainly because most studies were retrospective and the data came from medical records, which may be incomplete or incorrectly coded; few studies considered demographics or past medical history; and not all results were reported in all studies, the researchers explain.

However, this suggests that both the complications arising from medical tourism for elective surgery and the associated costs are likely to be underestimated, they add.

"There are areas of the UK, such as Wales and the South West of England, which are almost not represented [in published evidence]. "We did not identify any studies relating to other surgical specialties such as orthopedic surgery, and we did not identify any appropriate studies that were conducted in primary care or that considered longer-term follow-up," they point out.

"We still don't know how many people living in the UK go abroad for elective surgery, or how many people suffer complications afterwards. Without this data, we cannot fully understand the level of risk people having surgery abroad take," they point out.

“A systematic approach is needed to collect information about the number of people traveling abroad for elective surgery, as well as the frequency and impact of treatment of complications on the UK NHS,” they emphasize.

“Awareness campaigns and interventions are needed to inform the UK population considering surgery abroad of the possibility of complications.” they add.

“Anyone seeking medical treatment abroad should be aware of what complications the NHS is responsible for and what costs the patient may be personally liable for, including non-emergency treatment,” they suggest.

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