The patient perspective of bariatric surgery outcomes: Developing a 'core' set of patient-reported outcomes

Introduction: Patient-reported outcomes (PROs) are central to evaluating bariatric surgery. However there is a lack of consistency as to which outcomes to measure.
Objectives: To evaluate outcomes of importance to patients and to use this information to develop a core set of PROs.
Methods: Systematic reviews of PRO and qualitative research studies in bariatric surgery were undertaken to build a list of outcomes and investigate patient experience of bariatric surgery. Qualitative interviews were also undertaken with patients to elicit views of important outcomes. Data from all sources was grouped into health domains and a questionnaire drafted for a Delphi survey.
Results: 5679 abstracts were screened, with 86 PRO and 21 qualitative studies included. 68 validated PRO measures were identified, representing 254 different PROs. 36 themes were identified from the qualitative studies, of which one (‘development of new addictions after surgery’) was not already encompassed by the PROs. To date, seven qualitative interviews have been conducted which have yielded two additional themes (‘personal identity’ and ‘normality’). Three assessors grouped the list of PROs and themes into 20 broad health domains containing 96 items. Feedback was sought from patient representatives and the list reduced to 10 broad domains with 69 items for inclusion in a draft Delphi questionnaire.
Conclusion: Validated PRO measures are useful to assess patient experience of surgery over time. However, qualitative research can shed light on the complexity of experiences that quantitative measures cannot always access. Both approaches are needed to develop a core outcome set that truly reflects patient centred outcomes and experiences.

Coulman, K. D. Owen-Smith, A. Andrews, R. C. Chalmers, K. Ferguson, Y. Norton, S. Welbourn, R. Whale, K. Blazeby, J. M.