Long term follow-up with a bariatric specialist after a gastric bypass can decrease the risk of developing anaemia, new research suggests.

The study, published in JAMA Surgery, looked at anaemia rates in 74 patients who underwent Roux-en-Y gastric bypass at a US medical centre.

On average, one in five patients were anaemic before the operation, rising to one in two 10 years after the surgery.

But the anaemia rate rose markedly in the group of patients that did not see a bariatric specialist five years or more post surgery (rising from 22% pre-operatively  to 57% after a decade) compared to the group which had at least one appointment with a specialist in that time (a rise of 13% to 19%).

This led the authors to conclude that follow-up with bariatric specialists more than five years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anaemia risk.

“This finding may demonstrate the bariatric specialist’s specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation,” wrote the study authors.

“All patients receiving iron supplements who still had anaemia at 10 years were in the group without bariatric specialist follow-up (n = 11), a finding suggesting an inappropriate choice of treatment or inadequate follow-up.

The authors acknowledged the small size of the cohort with bariatric specialist follow-up was a major limitation of the study.

Dr George Hopkins, a Queensland-based bariatric surgeon, said the study findings while not surprising were a reflection of the difficulties of implementing the long-term multidisciplinary care which is so important after all bariatric interventions.

“The high volume surgical centres, such as mine, do require the expertise of dietitians and bariatric physicians to monitor and supervise bloodworks in a sustainable fashion,” said Dr Hopkins, who is past president of the Obesity Surgery Society of Australia and New Zealand.

“It is not practical or sustainable for the surgeon to co-ordinate directly but rather have in place the systems to prevent the described scenario of patients falling through the cracks,” he said.

“It should be emphasised the patient has a role to play in this algorithm too. No follow-up protocol succeeds in the absence of a focused patient.”