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

Outward medical tourism is when people seek medical treatment in a different country to the one they live in. There are concerns that people travelling abroad for surgery may be at risk of complications when they return home. This review aimed to identify all the studies that describe the impact on the UK NHS of patients who require follow-up care due to outward medical tourism for elective surgery and report on complications, costs and benefits. The review included evidence available until December 2024. 37 studies were included that described patients who were treated in the NHS for complications arising from elective surgery conducted abroad. 35 were case series or case reports, 19 relating to bariatric surgery, 15 to cosmetic surgery and 1 to ophthalmic surgery. 2 were surveys of plastic surgeons practicing in the NHS. 14 studies included a cost analysis. The case series and case reports included a total of 655 patients treated by the NHS between 2006 to 2024 for post-operative complications in specific hospitals. Not all studies reported all outcomes of interest. For the studies that reported demographic data, most patients were female (90%). The most common destination for surgery was Turkey (61%). For bariatric surgery tourism, abdominal pain, vomiting, inability to swallow and malnutrition were cited as presenting symptoms, with gastric leak being the most common diagnosis. Over a third of patients had to have a reversal or revision of the bariatric procedure. For cosmetic surgery tourism, the most common complications were infection and reopening of the surgical wound, with 57% of patients receiving antibiotics. No deaths were reported by any of the studies, although there was evidence that some patients needed complex treatment involving long hospital stays and multiple surgical interventions. Just over a half of patients required at least one investigation or intervention under local or general anaesthetic. Very low certainty of evidence indicates that costs to the NHS from outward medical tourism for elective surgery ranges from {pound}1,058 to {pound}19,549 per patient in 2024 prices. We found no studies that reported on benefits of outward medical tourism. Awareness-raising campaigns and interventions are warranted to inform members of the public considering going abroad for surgery about the potential for complications. 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 the associated costs. We still do not know how many people resident in the UK go abroad for elective surgery or how many people subsequently have complications. Without this data we cannot fully understand the amount of risk that people seeking surgery abroad are taking. Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.