Complications and costs to the NHS due to outward medical tourism for elective surgery: a rapid review

Background and Context 
Outward medical tourism refers to people traveling abroad for elective surgeries, such as weight loss, cosmetic, and eye surgeries. This practice has been growing due to the appeal of lower costs and reduced waiting times abroad. However, there are significant concerns about the potential complications that may arise post-surgery, which often necessitate follow-up care from the NHS upon the patients' return home.

Aims 
The rapid review aimed to identify studies that describe the impact on the UK NHS of patients needing follow-up care due to complications from elective surgeries performed abroad. It focused on understanding the types of complications, the costs involved, and any potential benefits to the NHS.

Strategy/Method       
The review included evidence available until December 2024, and included 37 studies. These studies were primarily case series or case reports, with a few surveys of plastic surgeons. The review looked at information in these studies, which included data from 655 patients treated by the NHS for complications arising from surgeries conducted abroad.

Findings/Outcomes                     
The most common complications from weight loss surgeries included abdominal pain, vomiting, inability to swallow, and malnutrition, with gastric leaks being prevalent. Cosmetic surgeries often resulted in infections and reopening of surgical wounds. No deaths were reported, but many patients required complex treatments involving long hospital stays and multiple surgical interventions.  

Costs to the NHS ranged from £1,058 to £19,549 per patient in 2024 prices. The highest costs were associated with longer hospital stays and surgical treatments. However, the certainty of the evidence for these costs was very low, and it was unclear if all relevant cases and associated costs were fully identified in the studies.

Impact – So What?
The findings emphasize the substantial burden on the NHS caused by complications from outward medical tourism. This includes both financial costs and the strain on NHS resources. The review highlights the need for better public awareness, and systematic data collection to fully understand the risks and impacts.

How will the research be used?
The research will help to inform policy decisions regarding the treatment of complications from surgeries performed abroad. It will aid in creating awareness campaigns to educate the public about potential risks and the importance of adhering to NHS criteria for elective surgeries.

How will it be of benefit in the real world?
By enhancing awareness and improving data collection, the NHS can more effectively manage follow-up care for patients who have undergone surgeries abroad. This can result in more efficient use of resources and potentially reduce the number of complications through better-informed patient decisions.

Key Findings
Complications: Common issues included abdominal pain, vomiting, infections, and surgical wounds reopening.
Costs: Treatment costs ranged significantly, with the highest costs associated with longer hospital stays and surgical treatments.
Demographics: Most patients were female, with Turkey being the most common destination for surgery.
Procedures: Sleeve gastrectomy was the most common weight loss surgery, while abdominoplasty was the most frequent cosmetic procedure.
Evidence gaps:  There is a need for a systematic approach to collecting information on the impact on the UK NHS of treating complications arising from outward medical tourism for elective surgery and associated costs. The scale of the problem in Wales is almost completely unknown.

Conclusion  
Outward medical tourism for elective surgeries poses a substantial challenge to the NHS, both in terms of costs and resource allocation. To address these issues, targeted awareness campaigns and enhanced access to weight management services within the NHS are essential.

Lay summary written by Beti-Jane Ingram, Public Partnership Group Member. 

To read the full report, click here.