UK patients seeking surgery overseas are returning with complications the NHS must treat

By Priyanjana Pramanik, MSc.Reviewed by Lauren HardakerJan 16 2026

A new review reveals how complications after overseas cosmetic and weight-loss surgery are landing back in UK hospitals, exposing serious risks for patients and unresolved pressures for the NHS.

Study: Complications and costs to the UK National Health Service due to outward medical tourism for elective surgery: a rapid review. Image credit: Pla2na/Shutterstock.com

In a recent study published in BMJ Open, researchers examined reported cases of complications linked to outward medical tourism from the UK, residents traveling abroad for elective surgery, and the implications for NHS care on patients’ return.

They found that outward medical tourism, mainly involving bariatric, metabolic, and cosmetic surgery, with only a small number of ophthalmic cases, can lead to serious postoperative complications requiring the use of NHS services.

Why more UK patients seek elective surgery abroad

Outward medical tourism refers to people travelling abroad to obtain elective medical procedures that are not urgently required. This practice has grown steadily over recent decades, as suggested by earlier estimates and policy analyses. It has been supported by low-cost international travel and online marketing by overseas providers. While such travel may benefit individual patients by reducing costs or shortening waiting times, it raises concerns for health systems in patients’ home countries.

For the UK NHS, outward medical tourism poses challenges because patients may return with complications requiring follow-up care, hospital admission, or further surgery. These complications can be difficult to manage when details of the original procedure are incomplete or unavailable. Previous evidence suggests that wound infections, poor healing, sepsis, and organ failure are among the most common and severe outcomes, particularly after cosmetic and bariatric surgery.

Although estimates suggest a large and growing number of UK residents seek medical care abroad, the scale, costs, and consequences for the NHS remain unclear. Earlier research highlighted variable motivations for travel, limited patient awareness of risks, and reliance on NHS services to manage complications.

Case reports, surveys, and cost data

Researchers conducted a rapid review design to synthesize UK-based evidence on the costs, complications, and benefits of outward medical tourism undertaken for elective procedures, seeking to provide insights for policy and practice. They followed recognized guidance for such reviews, adhered to established reporting standards, and prospectively registered the study.

Comprehensive searches were conducted across multiple medical and scientific databases, covering studies published during 2012, 24. Additionally, citation tracking and searches of grey literature were undertaken, with relevant earlier studies identified from a previous review.

Eligible studies were quantitative or descriptive UK-based reports examining complications, costs, or benefits to the NHS resulting from elective surgery undertaken abroad. Case reports, case series, surveys, conference abstracts, and grey literature were included, while opinion pieces were excluded. Emergency, cancer, fertility, dental, and transplant-related tourism were also excluded.

Screening and data extraction were primarily conducted by one reviewer, with quality checks by additional reviewers. Outcomes included types of surgery, complications, NHS resource use, and treatment costs. Data were synthesized narratively, complications graded where possible, and reported costs were adjusted to 2024 prices. The study quality and overall certainty of evidence were evaluated using standardized tools.

Complications followed bariatric and cosmetic surgery

The search identified 38 reports describing 37 studies published between 2007 and 2025. These studies reported on 655 patients treated by the NHS for complications following elective surgery abroad. Most evidence related to bariatric, metabolic surgery, 385 patients, and cosmetic surgery, 265 patients, while ophthalmic surgery accounted for only five reported cases. No studies reported benefits or savings to the NHS.

Most patients were women, around 90 percent, with an average age of 38 years. The most common destination country was Turkey, accounting for over 60 percent of reported cases. Sleeve gastrectomy was the most frequent bariatric procedure, while abdominoplasty and breast surgery dominated cosmetic procedures.

At least 53 percent of patients experienced severe complications, often requiring surgery, prolonged hospitalisation, or intensive treatment. Although no deaths were reported, hospital stays were substantial, averaging 17 days for bariatric surgery complications and 6 days for cosmetic surgery complications. These figures were derived from subsets of reported cases rather than from comprehensive national data.

Reported NHS costs ranged from £1,058 to £19,549 per patient at 2024 prices. Longer hospital stays and surgical interventions were the main drivers of cost. However, the evidence base was weak, and cost estimates were likely to be underreported due to missing or incomplete data.

Complications place demands on NHS specialist care

The rapid review shows that outbound medical tourism for elective surgery can result in serious complications that place considerable demands on NHS specialist hospital services, particularly in secondary and tertiary care, as reported. Most cases involved bariatric or cosmetic surgery, with no evidence of financial or system-level benefits to the NHS.

A major strength of the review is its comprehensive and systematic search, including grey literature, and its capture of data from over 650 patients. However, the evidence base is limited by retrospective case reports and small case series, high risk of bias, incomplete reporting, and poor generalisability. Many studies only included emergency presentations, likely underestimating the true burden.

Overall, there is little certainty about the evidence on costs, and key gaps remain, particularly regarding primary care impacts, long-term outcomes, and population-level estimates. The authors caution that current evidence does not allow reliable quantification of the overall national impact on the NHS. The findings highlight the need for clear NHS policy on postoperative responsibility, better public information about risks, and improved data collection to support informed decision-making and future health service planning.

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