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Patient Preparation for Bariatric Surgery pp 35–50Cite as

Comprehensive Medical Evaluation

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Abstract

The initial medical evaluation, which is conducted by a medical provider with familiarity with all obesity-related comorbid conditions that contribute to surgical risk, establishes the focus for the comprehensive medical evaluation. Extreme obesity is commonly associated with significant abnormalities in critical organ function, which are usually related to the extent and duration of obesity. The degree of obesity-related organ dysfunction must be carefully evaluated in order to complete a patient-centered risk assessment. Patients with significant cardio-pulmonary impairment should be evaluated for obese cardiomyopathy, pulmonary hypertension, obesity hypoventilation, severe sleep apnea, and thromboembolism risk. The comprehensive medical evaluation includes those specialty consultations and medical tests necessary to establish patient-centered health risks of extreme obesity and risks of bariatric surgery.

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References

  1. Benotti P, Wood G, Still C, Petrick A, Strodel W. Obesity disease burden and surgical risk. Surg Obes Relat Dis. 2006;2:600–6.

    Article  PubMed  Google Scholar 

  2. Poirier P, Alpert M, Fleisher L, Thompson PD, Sugerman H, Burke L, Marceau P, Franklin B. Cardiovascular evaluation and management of severely obese patients undergoing surgery. A science advisory from the American Heart Association. Circulation. 2009;120:86–95.

    Google Scholar 

  3. Salome C, King G, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol. 2010;108:206–11.

    Article  PubMed  Google Scholar 

  4. Jones R, Nzekwu M. The effect of body mass index on lung volumes. Chest. 2006;130: 827–33.

    Article  PubMed  Google Scholar 

  5. Sekhri V, Faheem A, Chul W, Ahn L, DeLorenzo L, Aronow W, et al. Impact of morbid obesity on pulmonary function. Arch Med Sci. 2008;4:66–70.

    Google Scholar 

  6. Saliman J, Benditt J, Flum D, Oelschlager B, Dellinger E, Goss C. Pulmonary function in the morbidly obese. Surg Obes Relat Dis. 2008;4:632–9.

    Article  PubMed  Google Scholar 

  7. Gabrielsen A, Lund M, Kongerud J, Viken K, Roislien J, Hjelmesaeth J. The relationship between anthropometric measures, blood gases, and lung function in morbidly obese white subjects. Obes Surg. 2011;21:485–91.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hamoui N, Anthone G, Crookes P. The value of pulmonary function testing prior to bariatric surgery. Obes Surg. 2006;16:1570–3.

    Article  PubMed  Google Scholar 

  9. Kabon B, Negele A, Reddy D, Eagon C, Fleshman J, Sessler D, et al. Obesity decreases tissue oxygenation. Anesthesiology. 2004;100:274–80.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Shah N, Roux F. The relationship of obesity and obstructive sleep apnea. Clin Chest Med. 2009;30:455–65.

    Article  PubMed  Google Scholar 

  11. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  12. Sareli A, Cantor C, Williams N, Korus G, Raper S, Pien G, et al. Obstructive sleep apnea inn patients undergoing bariatric surgery – a tertiary center experience. Obes Surg. 2011;21: 316–27.

    Article  PubMed  Google Scholar 

  13. Polotsky V, Susheel P, Savransky V, et al. Obstructive sleep apnea, insulin resistance, and steatohepatitis in severe obesity. Am J Respir Crit Care Med. 2009;179:228–34.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Vasu T, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systemic review of the literature. J Clin Sleep Med. 2012;8:199–207.

    PubMed Central  PubMed  Google Scholar 

  15. Dela Cruz C, Matthay R. Role of obesity in cardiomyopathy and pulmonary hypertension. Clin Chest Med. 2009;30:509–23.

    Article  PubMed  Google Scholar 

  16. Maciejewski M, Winegar D, Farley JF, Wolfe B, DeMaria E. Risk stratification of serious adverse events after gastric bypass in the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2012;8:671–8.

    Article  PubMed  Google Scholar 

  17. Johns M. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.

    CAS  PubMed  Google Scholar 

  18. Maislin G, Pack A, Kribbs N, Smith P, Schwartz A, Kline L, et al. A survey screen for prediction of apnea. Sleep. 1995;18:158–66.

    CAS  PubMed  Google Scholar 

  19. Arias M, Garcia-Rio F, Alphonso-Fernandez A, Martinez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure. a randomized cross-over study. Euro Heart J. 2006;27:1106–13.

    Article  Google Scholar 

  20. Burwell C, Robin E, Whaley R, Bickelmann A. Extreme obesity associated with alveolar hypoventilation: a Pickwickian syndrome. Am J Med. 1956;21:811–8.

    Article  PubMed  Google Scholar 

  21. Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010;55:1347–62.

    PubMed  Google Scholar 

  22. Khan M, Wood K, Bhatt N. Obesity hypoventilation syndrome. Sleep Med Clin. 2008;3:525–39.

    Article  Google Scholar 

  23. Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans A. Obesity hypoventilation syndrome prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11:117–24.

    Article  PubMed  Google Scholar 

  24. Nowbar S, Burkart K, Gonzales R, Fedorowicz A, Gozansky W, Gaudio J, et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med. 2004;116:1–7.

    Article  PubMed  Google Scholar 

  25. Littleton S, Mokhlesi B. The Pickwickian syndrome—obesity hypoventilation syndrome. Clin Chest Med. 2009;30:467–78.

    Article  PubMed  Google Scholar 

  26. Chau E, Lam D, Wong J, Mokhlesi B, Chung F. Obesity hypoventilation syndrome. A review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology. 2012;117:118–205.

    Article  Google Scholar 

  27. Klein S, Burke L, Bray G, Blair S, Allison D, Pi-Sunyer X, et al. Clinical implications of obesity with specific focus on cardiovascular disease. A statement for professionals from the American Heart Association Council on Nutrition, Physical Activity and Metabolism. Circulation. 2004;110:2952–67.

    Article  PubMed  Google Scholar 

  28. Poirier P, Cornier M, Mazzone T, Stiles S, Cummings S, Klein S, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123:1683–701.

    Article  PubMed  Google Scholar 

  29. Nielsen S. Measurement of blood flow in adipose tissue from the washout of Xenon-133 after atraumatic labeling. Acta Physiol Scand. 1972;84:187–96.

    Article  CAS  PubMed  Google Scholar 

  30. Alpert M. Obesity cardiomypoathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321:225–36.

    Article  CAS  PubMed  Google Scholar 

  31. Smith H, Willus F. Adiposity of the heart. Arch Intern Med. 1933;52:929–31.

    Article  Google Scholar 

  32. Alpert M, Terry B, Mulekar M, Cohen M, Massey C, Fan T, et al. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol. 1997;80:736–40.

    Article  CAS  PubMed  Google Scholar 

  33. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–18.

    Article  PubMed  Google Scholar 

  34. McGavock J, Victor R, Unger R, Szczepaniak L. Adiposity of the heart, revisited. Ann Intern Med. 2006;144:517–24.

    Article  CAS  PubMed  Google Scholar 

  35. Livingston E, Arterburn D, Schifftner T, Hendersonn W, DePalma R. National Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203:625–33.

    Article  PubMed  Google Scholar 

  36. Lee T, Mercantonio E, Mangione C, Thomas E, Carisi A, Polanczyk C, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  PubMed  Google Scholar 

  37. Fleisher L, Beckman J, Brown K, Calkins H, Chaikof E, Fleischmann K, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2007;116:e418–99.

    Article  PubMed  Google Scholar 

  38. Gallagher M, Franklin B, Ehrman J, Keteyian S, Brawer C, deJong A, et al. Comparative impact of morbid obesity vs heart failure on cardiorespiratory fitness. Chest. 2005;127:2197–203.

    Article  PubMed  Google Scholar 

  39. McCullough P, Gallagher M, deJong A, Sandberg K, Trivax J, Alexander D, et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130:517–25.

    Article  PubMed  Google Scholar 

  40. Hansen C, Woodhouse S, Kramer M. Effect of patient obesity on the accuracy of thallium-201 myocardial perfusion imaging. Am J Cardiol. 2000;85:749–54.

    Article  CAS  PubMed  Google Scholar 

  41. Poise Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.

    Article  Google Scholar 

  42. Kaafaranin A, Atluri P, Thornby J, Itani K. β blockade in non-cardiac surgery: outcome at all levels of cardiac risk. Arch Surg. 2008;143:940–4.

    Article  Google Scholar 

  43. Benotti P, Wood G, Winegar D, Petrick A, Still C, Argyropoulos G, Gerhard G. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2014;259(1):123–30.

    Article  PubMed  Google Scholar 

  44. Shah S. Pulmonary hypertension. JAMA. 2012;308:1366–74.

    Article  CAS  PubMed  Google Scholar 

  45. Chin K, Rubin L. Pulmonary arterial hypertension. J Am Coll Cardiol. 2008;51:1527–38.

    Article  PubMed  Google Scholar 

  46. Hoeper M, Barbera J, Channick R. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol 2009;54(Suppl S):S85–96.

    Google Scholar 

  47. Simonneau G, Robbins I, Beghetti M, Channick M, Delcroix M, Denton C, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2009;54(Suppl S): S43–54.

    Google Scholar 

  48. McQuillan B, Picard M, Leavitt M, Weyman A. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104:2797–802.

    Article  CAS  PubMed  Google Scholar 

  49. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest. 1996;109:380–6.

    Article  CAS  PubMed  Google Scholar 

  50. O’Hearn D, Gold A, Gold M, Diggs P, Scharf S. Lower extremity edema and pulmonary hypertension in morbidly obese patients with obstructive sleep apnea. Sleep Breath. 2009;13:25–34.

    Article  PubMed  Google Scholar 

  51. Friedman S, Andrus B. Obesity and pulmonary hypertension: a review of pathophysiologic mechanisms. J Obes 2012;Article ID 505274. Published on line Sept 2012.

    Google Scholar 

  52. Barst R, McGoon M, Torbicki A, Sitbon O, Krowka M, Olschewski H et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;43(12 Suppl S):40S–7S.

    Google Scholar 

  53. Pengo V, Lensing A, Prins M, Marchiori A, Davidson B, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257–64.

    Article  CAS  PubMed  Google Scholar 

  54. Wong C, O’Moore-Sullivan T, Leano R, Hukins C, Jenkins C, Marwick TH. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol. 2006;47:611–6.

    Article  PubMed  Google Scholar 

  55. Enright P. The six-minute walk test. Respir Care. 2003;48:783–5.

    PubMed  Google Scholar 

  56. American Thoracic Society. ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.

    Article  Google Scholar 

  57. Stein P, Beematn A, Olson R. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118:978–80.

    Article  PubMed  Google Scholar 

  58. Stein P, Goldman J. Obesity and thromboembolic disease. Clin Chest Med. 2009;30:489–93.

    Article  PubMed  Google Scholar 

  59. Finks J, English W, Carlin A, Krause K, Share D, Banerjee M, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255:1100–4.

    Article  PubMed  Google Scholar 

  60. Winegar D, Pate V, Quinn S, DeMaria E. Venous thromboembolism (vte) following bariatric surgery performed by Bariatric Centers of Excellence (BSCOE): analysis of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6(Suppl):S2.

    Article  Google Scholar 

  61. Sapala J, Wood M, Schuhknecht M. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13:819–25.

    Article  PubMed  Google Scholar 

  62. Melinek J, Livingston E, Cortina G, Fishbein M. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med. 2002;126:1091–5.

    PubMed  Google Scholar 

  63. Finks J, Kole K, Yenumula P, English W, Krause K, Carlin A, et al. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2011;254:633–40.

    Article  PubMed  Google Scholar 

  64. DeMaria E, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3(2):134–40.

    Article  PubMed  Google Scholar 

  65. Vague J, Alessi M, Mavri A, Morange P. Plasminogen activator inhibitor-1, obesity, insulin resistance and vascular risk. J Thromb Haemost. 2003;1:1575–9.

    Article  Google Scholar 

  66. Kohler H, Grant P. Plasminogen-activator inhibitor type i and coronary artery disease. N Engl J Med. 2000;342:1792–801.

    Article  CAS  PubMed  Google Scholar 

  67. Shantsila E, Kamphuisen P, Lip G. Circulating microparticles in cardiovascular disease: implications for atherogenesis and atherothrombosis. J Thromb Hemost. 2010;8:2358–68.

    Article  CAS  Google Scholar 

  68. Goichot B, Grunebaum L, Desprez D, Vinzio S, Meyer L, Schlienger J, et al. Circulating procoagulant microparticles in obesity. Diabetes Metab. 2006;32:82–5.

    Article  CAS  PubMed  Google Scholar 

  69. Hanzu F, Palomo M, Kalko S, Parrizas M, Garaulet M, Escolar G, et al. Translational evidence of endothelial damage in obese individuals: inflammatory and prothrombotic responses. J Throm Hemost. 2011;9:1236–45.

    Article  CAS  Google Scholar 

  70. Overby D, Kohn G, Cahan M, Galanko J, Colton K, Moss S, et al. Prevalence of thrombophilias in patients presenting for bariatric surgery. Obes Surg. 2009;19:1278–85.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Obesity Institute, Geisinger Medical Center, Southold, NY, USA

    Peter N. Benotti (Senior Clinical Investigator)

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Benotti, P.N. (2014). Comprehensive Medical Evaluation. In: Patient Preparation for Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0906-3_6

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  • DOI: https://doi.org/10.1007/978-1-4939-0906-3_6

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