Evidence map›Paper›PMID 41529913›Full record

ReviewBMJ open2026

Complications and costs to the UK National Health Service due to outward medical tourism for elective surgery: a rapid review.

Clare England, Nathan Bromham, Antonia Needham-Taylor, Juliet Hounsome, Elizabeth Gillen, Beti-Jane Ingram, Jacob Davies, Adrian Edwards, Ruth Lewis

Abstract readReview
In one paragraph

Review in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Clare EnglandHealth Technology Wales, Cardiff, UK clare.england2@wales.nhs.uk.ORCID http://orcid.org/0000-0003-0685-0690
Nathan BromhamHealth Technology Wales, Cardiff, UK.
Antonia Needham-TaylorHealth Technology Wales, Cardiff, UK.
Juliet HounsomeSpecialist Unit for Review Evidence, Cardiff University, Cardiff, UK.
Elizabeth GillenWales Centre for Evidence-Based Care, Cardiff University, Cardiff, UK.
Beti-Jane IngramHealth and Care Research Wales Evidence Centre, Cardiff University, Cardiff, UK.
Jacob DaviesCentre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK.
Adrian EdwardsHealth and Care Research Wales Evidence Centre, Cardiff University, Cardiff, UK.ORCID http://orcid.org/0000-0002-6228-4446
Ruth LewisHealth and Care Research Wales Evidence Centre, Cardiff University, Cardiff, UK.ORCID http://orcid.org/0000-0003-0745-995X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesOutward medical tourism is when people seek medical treatment in a different country to the one they live in. We aimed to identify all studies that describe the impact on the UK National Health Service (NHS) of patients who require treatment due to outward medical tourism for elective surgery and report on complications, costs and benefits.

designA rapid literature review. Medical and grey literature databases were searched, limited to literature published between 2012 and 2024. SELECTION CRITERIA: Studies published in the English language, conducted in any NHS setting, describing complications, costs or benefits due to outward medical tourism for elective surgery were included. We excluded emergency and semi-urgent surgery, dental and transplant surgery, cancer treatment and fertility treatment. OUTCOME MEASURES: Primary outcomes were costs and savings to the NHS. Secondary outcomes were type and frequency, demographics, procedures, complications, treatment, follow-up care and use of NHS resources. Results were summarised narratively. Study quality was assessed using JBI critical appraisal tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for certainty of evidence for costs.

resultsSome 35 case series and case reports and two surveys of NHS plastic surgeons were identified. Case studies described 655 patients treated in specific NHS hospitals between 2006 and 2024 for postoperative complications due to metabolic/bariatric surgery (n=385), cosmetic (n=265) and ophthalmic (n=5) surgery tourism. No cases relating to other surgical specialities were identified in the literature. Most patients were women (90%), with an average age of 38 (range 14-69) years. The most common destination for surgery was Turkey (61%). Complications were not well described for metabolic/bariatric surgery tourism; but for cosmetic surgery tourism, infection and wound dehiscence were most commonly reported. There was evidence that some patients needed complex treatment involving long hospital stays and multiple surgical interventions. Very low certainty evidence indicated that costs to the NHS from outward medical tourism for elective surgery ranged from £1058 to £19 549 per patient in 2024 prices. We found no studies that reported on the benefits of outward medical tourism.

conclusionsA systematic approach is needed to collecting information on the number of people who travel abroad for elective surgery and the frequency and impact on the UK NHS of treating complications. Without these data, we cannot fully understand the risk of seeking surgery abroad.

Indexed as

Elective Surgical ProceduresHealth Care CostsMedical TourismPostoperative ComplicationsState MedicineCost-Benefit AnalysisHumansUnited KingdomHealth policyReviewSURGERY

Identifiers

PMID41529913
PMCPMC12815047

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.