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Medical Management Before Bariatric Surgery

  • Obesity and Diet (G. Rao, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The evaluation of patients before bariatric surgery requires identification and optimization of the known comorbidities associated with obesity. Evaluation begins with cardiac and pulmonary assessment for elective noncardiac surgery for patients with severe obesity published in Circulation in 2009 by the AHA.1 The algorithm uses a 5-step approach and evaluation after a comprehensive history and physical exam and lab testing completed.

Recent Findings

A standardized preoperative checklist and Clinical Practice Guidelines were updated in 2013 by the American Associations of Clinical Endocrinologists (ACCE), The Obesity Society (TOS), and the American Society for Metabolic and Bariatric Surgery (ASMBS). The Clinical Practice Guidelines have 74 recommendations for the preoperative evaluation of the bariatric surgery patient including lab testing, nutritional screening, endocrine evaluation, and the cardiopulmonary evaluation including sleep apnea screening. During the medical evaluation usually within 2–4 weeks before bariatric surgery, the use of an additional algorithm from the AHA/ACC utilizes a 7-step algorithm to determine a patient’s functional capacity, cardiopulmonary risk, and the need for further cardiac evaluation to include stress testing, cardiology, or pulmonary evaluation.

Summary

In summary, utilization of the AHA science advisory cardiac and pulmonary assessment of the patient with severe obesity before bariatric surgery is extremely helpful in a timely diagnosis, management, and optimization of comorbid conditions that can impact postoperative outcomes.

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Notes

  1. Porier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009; 120 (1): 86–95.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Cleveland Clinic Foundation, Bariatric and Metabolic Institute, Digestive Disease Surgery Institute, M-61, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Scott Butsch & Derrick Cetin

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  1. Scott Butsch
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Correspondence to Derrick Cetin.

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Dr. Butsch declares that the only disclosure is an interest in Novo Nordisk.

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Butsch, S., Cetin, D. Medical Management Before Bariatric Surgery. Curr Cardiovasc Risk Rep 14, 2 (2020). https://doi.org/10.1007/s12170-019-0636-7

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