Perioperative Management of the Bariatric Surgery Patient

  • Sean A. A. WoodcockEmail author


The perioperative care of the bariatric surgical patient is provided by the multidisciplinary bariatric team with patient safety being paramount. Patients should be adequately assessed and risk factors identified and managed prior to surgery to optimize patient outcomes. Such care can be divided into preoperative, perioperative and immediate postoperative care, up until the patient is discharged from the bariatric unit. Apart from addressing the medical and psychological issues of the patients,’ the in-hospital experience of the patients should also be taken care of. Units should have adequate equipment and fully trained staff to look after the morbidly obese, with enough space to care for and ensure patient dignity and respect. Good communication between the surgical, medical, allied health professional and primary care is essential at this time of the patients’ pathway to promote the high standard of care that bariatric surgery patients need. This chapter deals with these issues and is illustrated with the practical aspects of care that is offered at the author’s place of work.


Perioperative Preoperative Postoperative Assessment Multidisciplinary Bariatric Obesity Surgery 


  1. 1.
    NHS commissioning board clinical reference group for severe and complex obesity. Clinical commissioning policy: complex and specialized obesity surgery. April 2013. Reference: NHSCB/A05/P/a. Available online at:
  2. 2.
    National Institute for Health and Clinical Excellence, National Collaborating Centre for Primary Care. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children, NICE clinical guidelines, No. 43. London: NICE; 2006.Google Scholar
  3. 3.
    Cook TM, Woodall N, Frerk CO. Major complications of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg. 2007;31(3):556–60; discussion 561.CrossRefPubMedGoogle Scholar
  5. 5.
    Sareli AE, Cantor CR, Williams NN, Korus G, Raper SE, Pien G, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21(3):316–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.PubMedGoogle Scholar
  7. 7.
    Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High stop-bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Chau EH, Lam D, Wong J, Mokhlesi B, Chung F. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology. 2012;117(1):188–205.CrossRefPubMedGoogle Scholar
  9. 9.
    Budweiser S, Riedl SG, Jörres RA, Heinemann F, Pfeifer M. Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med. 2007;261(4):375–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the national health and nutrition examination survey, 1999 to 2004. J Am Coll Surg. 2008;207(6):928–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Rizzi CF, Cintra F, Mello-Fujita L, Rios LF, Mendonca ET, Feres MC, et al. Does obstructive sleep apnea impair the cardiopulmonary response to exercise? Sleep. 2013;36(4):547–53.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Hennis PJ, Meale PM, Hurst RA, O’Doherty AF, Otto J, Kuper M, et al. Cardiopulmonary exercise testing predicts postoperative outcome in patients undergoing gastric bypass surgery. Br J Anaesth. 2012;109(4):566–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Livingston EH, Arterburn D, Schifftner TL, Henderson WG, DePalma RG. National surgical quality improvement program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203(5):625–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Marchini JF, Souza FL, Schmidt A, Cunha SF, Salgado W, Marchini JS, et al. Low educational status, smoking, and multidisciplinary team experience predict hospital length of stay after bariatric surgery. Nutr Metab Insights. 2012;5:71–6.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268–79.CrossRefPubMedGoogle Scholar
  16. 16.
    Pearce EN. Thyroid hormone and obesity. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):408–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Thorell A, Hagström-Toft E. Treatment of diabetes prior to and after bariatric surgery. J Diabetes Sci Technol. 2012;6(5):1226–32.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis. 2006;2(2):98–103;discussion 104.CrossRefPubMedGoogle Scholar
  19. 19.
    Papasavas PK, Gagné DJ, Donnelly PE, Salgado J, Urbandt JE, Burton KK, et al. Prevalence of helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic roux-en-y gastric bypass. Surg Obes Relat Dis. 2008;4(3):383–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Lewis MC, Phillips ML, Slavotinek JP, Kow L, Thompson CH, Toouli J. Change in liver size and fat content after treatment with optifast very low calorie diet. Obes Surg. 2006;16(6):697–701.CrossRefPubMedGoogle Scholar
  21. 21.
    Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, van Dielen F, Wiezer R, Janssen I, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146(11):1300–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Bissar L, Almoallim H, Albazli K, Alotaibi M, Alwafi S. Perioperative management of patients with rheumatic diseases. Open Rheumatol J. 2013;7:42–50.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Harrell JW, Miller B. Big challenge. Designing for the needs of bariatric patients. Health Facil Manage. 2004;17(3):34–8.PubMedGoogle Scholar
  24. 24.
    Brodsky JB. Positioning the morbidly obese patient for anesthesia. Obes Surg. 2002;12(6):751–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient’s body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010;24(6):1398–402.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Steele KE, Schweitzer MA, Prokopowicz G, Shore AD, Eaton LC, Lidor AO, et al. The long-term risk of venous thromboembolism following bariatric surgery. Obes Surg. 2011;21(9):1371–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Weingarten TN, Sprung J, Flores A, Baena AM, Schroeder DR, Warner DO. Opioid requirements after laparoscopic bariatric surgery. Obes Surg. 2011;21(9):1407–12.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryNorth Tyneside HospitalNorth ShieldsUK

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