Preoperative Checklist for Bariatric Surgery
Bariatric and metabolic surgery is more effective than medical therapy for patients with morbid obesity as well as patients with type II diabetes mellitus and class I and II obesity (BMI more than 30 kg/m2) (Khan et al., Eur J Nutr 55:25–43, 2016; Adams et al., N Engl J Med 357:753–61, 2007; Khan et al., Health Commun 1–8, 2017; Fischer et al., Obes Surg 27:1684–90, 2017; Sjöström et al., Engl J Med 357:741–52, 2007; Keating et al., Diabetes Care 32:580–4, 2009; Schauer et al., N Engl J Med 376:641–51, 2017; Ikramuddin et al., JAMA 309:2240–9, 2013). However, the process of undergoing bariatric and metabolic surgery requires the setup of a multidisciplinary team (MDT) (Mingrone et al., Lancet 386:964–73, 2015). This MDT will allow for appropriate preoperative evaluation, adequate perioperative facility setup, as well as postoperative lifelong follow-up. In addition, the MDT is needed to ensure ample patient education, engagement and setting realistic expectation for the process of workup, potential perioperative complications, and the need for lifelong follow-up. In this chapter, we will review the minimum required multidisciplinary team setup, a proposed pathway for preoperative evaluation, recommended infrastructure in the perioperative period, as well as a proposed structure for lifelong follow-up after bariatric surgery. In addition, we will review the members of the MDT, preoperative checklist for patients undergoing bariatric and metabolic surgery in primary, revisional bariatric surgery (for weight regain or complications after bariatric surgery), adolescent patients, and high-risk patients. The preoperative checklist will include different pathways including outpatient, anesthesia, inpatient, and emergency department pathways. Furthermore, we present a proposed algorithm to screen patients for obstructive sleep apnea and manage patients with anemia and components of the smoking cessation program.
KeywordsMultidisciplinary team Primary bariatric surgery Revisional bariatric surgery Lifelong follow-up
Body mass index
Obstructive sleep apnea
- STOP BANG
Snoring, tiredness, observed apnea, previous history of HTN, BMI > 35, age > 55, neck circumference > 35 cm females and 40 cm in males, and gender male
- Type II DM
Type II diabetes mellitus
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