Preoperative Checklist for Bariatric Surgery

Chapter

Abstract

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.

Keywords

Multidisciplinary team Primary bariatric surgery Revisional bariatric surgery Lifelong follow-up 

Abbreviations

BMI

Body mass index

MDT

Multidisciplinary team

OSA

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

References

  1. 1.
    Khan TA, Sievenpiper JL. Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes. Eur J Nutr. 2016;55(Suppl 2):25–43.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Khan SS, Tarrant M, Weston D, Shah P, Farrow C. Can raising awareness about the psychological causes of obesity reduce obesity stigma? Health Commun. 2017:1–8.Google Scholar
  4. 4.
    Fischer L, Wekerle AL, Sander J, Nickel F, Billeter AT, Zech U, Bruckner T, Müller-Stich BP. Is there a reason why obese patients choose either conservative treatment or surgery? Obes Surg. 2017;27(7):1684–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM, Swedish obese subjects study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Keating CL, Dixon JB, Moodie ML, Peeters A, Playfair J, O’Brien PE. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32(4):580–4.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR, STAMPEDE investigators. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sl I, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, Thomas AJ, Leslie DB, Chong K, Jeffery RW, Ahmed L, Vella A, Chuang LM, Bessler M, Sarr MG, Swain JM, Laqua P, Jensen MD, Bantle JP. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.CrossRefGoogle Scholar
  9. 9.
    Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Delegates of the 2nd diabetes surgery summit metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Obes Surg. 2017;27(1):2–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35(7):1420–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Yan Y, Sha Y, Yao G, Wang S, Kong F, Liu H, Zhang G, Zhang H, Hu C, Zhang X. Roux-en-Y Gastric bypass versus medical treatment for type 2 diabetes mellitus in obese patients: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(17):e3462.CrossRefGoogle Scholar
  13. 13.
    Buchwald H. Consensus conference statement, bariatric surgery for morbid obesity: health implications for patients, health care professionals and third party payers. ASBS SOARD. 2004;2005:371–81.Google Scholar
  14. 14.
    Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382–94.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S, American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–S27.CrossRefGoogle Scholar
  16. 16.
    Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6 Pt 2):544–57.CrossRefPubMedGoogle Scholar
  17. 17.
    Marek RJ, Heinberg LJ, Lavery M, Merrell Rish J, Ashton K. A review of psychological assessment instruments for use in bariatric surgery evaluations. Psychol Assess. 2016;28(9):1142–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Sogg S, Lauretti J, West-Smith L. ASMBS guidelines/statements recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis. 2016;12:731–49.CrossRefPubMedGoogle Scholar
  19. 19.
    Omalu BI, Ives DG, Buhari AM, Lindner JL, Schauer PR, Wecht CH, Kuller LH. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142(10):923–928; discussion 929.Google Scholar
  20. 20.
    Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, Azarbad L, Ryee MY, Woodson M, Miller A, Schirmer B. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med. 2005;67(5):825–32.CrossRefPubMedGoogle Scholar
  21. 21.
    https://asmbs.org/professional-education/cbn bariatric nurse coordinator.
  22. 22.
    Pouwels S, Smeenk FW, Manschot L, Lascaris B, Nienhuijs S, Bouwman RA, Buise MP. Perioperative respiratory care in obese patients undergoing bariatric surgery: implications for clinical practice. Respir Med. 2016;117:73–80.CrossRefPubMedGoogle Scholar
  23. 23.
    Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5):1116–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Ren CJ. Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery? review. Obes Surg. 2004;14(3):313–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Felsenreich DM, Kefurt R, Schermann M, Beckerhinn P, Kristo I, Krebs M, Prager G, Langer FB. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2748-9. [Epub ahead of print].
  27. 27.
    Genco A, Soricelli E, Casella G, Maselli R, Castagneto-Gissey L, Di Lorenzo N, Basso N. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated longterm complication. Surg Obes Relat Dis. 2017;13(4):568–74. https://doi.org/10.1016/j.soard.2016.11.029. Epub 2016 Dec 9.
  28. 28.
    Yermilov I, McGory ML, Shekelle PW, Ko CY, Maggard MA. Appropriateness criteria for bariatric surgery: beyond the NIH guidelines. Obesity (Silver Spring). 2009;17(8):1521–7.CrossRefGoogle Scholar
  29. 29.
    Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts. 2008;1(1):52–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108.Google Scholar
  31. 31.
    Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. Perioperative safety in the longitudinal assessment of bariatric surgery. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. N Engl J Med. 2009;361(5):445–54.CrossRefPubMedGoogle Scholar
  32. 32.
    ASMBS Clinical Issues Committee. Peri-operative management of obstructive sleep apnea. Surg Obes Relat Dis. 2012;8(3):e27–32.CrossRefGoogle Scholar
  33. 33.
    Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, Mokhlesi B, Chung F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Zheng J, Zhao M, Li J, Lou G, Yuan Y, Bu S, Xi Y. Obesity-associated digestive cancers: a review of mechanisms and interventions. Tumour Biol. 2017;39(3):1010428317695020.CrossRefPubMedGoogle Scholar
  35. 35.
    Adams TD, Stroup AM, Gress RE, Adams KF, Calle EE, Smith SC, Halverson RC, Simper SC, Hopkins PN, Hunt SC. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.CrossRefGoogle Scholar
  36. 36.
    Al Hadad M, Dehni N, Alakhras A, Ziaei Y, Turrin NP, Nimeri A. Screening colonoscopy in the initial workup of bariatric surgery patients: guidelines are needed. Surg Endosc. 2014;28(5):1607–12.CrossRefPubMedGoogle Scholar
  37. 37.
    Quagliariello V, Rossetti S, Cavaliere C, Di Palo R, Lamantia E, Castaldo L, Nocerino F, Ametrano G, Cappuccio F, Malzone G, Montanari M, Vanacore D, Romano FJ, Piscitelli R, Iovane G, Pepe MF, Berretta M, D’Aniello C, Perdonà S, Muto P, Botti G, Ciliberto G, Veneziani BM, De Falco F, Maiolino P, Caraglia M, Montella M, Iaffaioli RV, Facchini G. Metabolic syndrome, endocrine disruptors and prostate cancer associations: biochemical and pathophysiological evidences. Oncotarget. 2017;8(18):30606–16.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Stallones RA. The association between tobacco smoking and coronary heart disease. Int J Epidemiol. 2015;44(3):735–43.CrossRefPubMedGoogle Scholar
  39. 39.
    Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in cardiovascular mortality: possible causes and implications. Circ Res. 2017;120(2):366–80.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Haskins IN, Nowacki AS, Khorgami Z, Schulz K, Heinberg LJ, Schauer PR, Brethauer SA, Aminian A. Should recent smoking be a contraindication for sleeve gastrectomy? Surg Obes Relat Dis. 2017;13(7):1130–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Nimeri A, Al Hadad M, Khoursheed M, Maasher A, Al Qahtani A, Al Shaban T, Fawal H, Safadi B, Alderazi A, Abdalla E, Bashir A. The Peri-operative Bariatric Surgery Care in the Middle East Region. Obes Surg. 2017;27(6):1543–7.CrossRefPubMedGoogle Scholar
  42. 42.
  43. 43.
    American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2013;9(4):493–7.CrossRefGoogle Scholar
  44. 44.
    Birkmeyer NJ, Finks JF, Carlin AM, Chengelis DL, Krause KR, Hawasli AA, Genaw JA, English WJ, Schram JL, Birkmeyer JD, Michigan Bariatric Surgery Collaborative. Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch Surg. 2012;147(11):994–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Aminian A, Andalib A, Khorgami Z, Cetin D, Burguera B, Bartholomew J, Brethauer SA, Schauer PR. Who should get extended thromboprophylaxis after bariatric surgery?: a risk assessment tool to guide indications for post-discharge pharmacoprophylaxis. Ann Surg. 2017;265(1):143–50.CrossRefPubMedGoogle Scholar
  46. 46.
    Nimeri AA, Gamaleldin MM, McKenna KL, Turrin NP, Mustafa BO. Reduction of venous thromboembolism in surgical patients using a mandatory risk-scoring system: 5-year follow-up of an American College of Surgeons National Surgical Quality Improvement Program. Clin Appl Thromb Hemost. 2017;23(4):392–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Nimeri AA, Bautista J, Ibrahim M, Philip R, Al Shaban T, Maasher A, Altinoz A. Mandatory risk assessment reduces venous thromboembolism in Bariatric surgery patients. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2909-x. [Epub ahead of print].
  48. 48.
    Eagan MC. Bariatric surgery: malpractice risks and risk management guidelines. Am Surg. 2005;71(5):369–75.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bariatric & Metabolic Institute (BMI) Abu Dhabi, Chief, Division of General, Thoracic and Vascular Surgery, Adjunct Associate Professor of SurgeryAbu DhabiUnited Arab Emirates

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