Page 155 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Considered all research above we developed a new screening tool for reimbursement of BCS in chapter 7. This tool was a modification of the screening tool developed by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). It consists of a questionnaire from which a score is calculated using information re- garding weight loss, the medical, physical and psychological problems caused by excess skin and medical history. We added the BODY-Q to the tool, so that patient reported outcome could be assessed. The BODY-Q is a validated patient reported outcome measure (PROM) specifically designed for the bariatric patient. Thereby set- ting the first steps to include patient well-being in decision making for reimbursement, which is lacking in the current Dutch system.
The patients who desired BCS scored significantly higher on the screening tool com- pared to patients who did not. The patients who qualified for reimbursement had a stable weight, higher %TWL, lower current BMI and more medical and psychological complaints compared to patients who did not qualify for referral. Thus, the tool seems to select patients who desire BCS, have the best weight loss results and the most complaints because of the excess skin. With the BODY-Q we showed that excess skin has a significant impact on several aspects of HRQoL. With these results we slightly modified the BAPRAS screening tool and created a new version: the Dutch ReBoc tool (Referral and Reimbursement for Body Contouring tool).
In conclusion, this thesis proved that preoperative, self-reported binge eating, dei- pressive symptoms, eating style and physical activity are not predictive of weight loss after surgery. And that these factors should not immediately warrant denial for bariat- ric surgery. It also showed that postoperative physical and psychological factors are related to weight loss and thereby HRQoL after bariatric surgery. In addition, factors like body image, weight loss and depressive symptoms are also related to each other. Counselling in bariatric patients should thus include these factors, so that weight loss results can be improved.
This thesis also showed that overhanging skin has a significant impact on patient well-being. Patients with excess skin and a desire for BCS had a more negatif body iamge, more depressive symptoms and a lower HRQoL. All these factors are currently not included in the reimbursement criteria for BCS. Efforts should be made to develop en new Dutch guideline for reimbursment in which these factors are included.
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