Preoperative Care of the Bariatric Patient

  • David S. TichanskyEmail author
  • Ranjan Sudan


Preoperative care of the bariatric patient starts before the patient arrives. Both evaluation and individualized risk assessment are essential for achieving best outcomes and allowing the patient to give a truly informed consent. Best preoperative care will yield a comprehensive understanding of a patient’s medical history as it pertains to predicted outcomes, cardiac health, venous thromboembolism risk, sleep architecture and pulmonary function, gastroesophageal anatomy and Helicobacter pylori status, and psychological ability to comply with required postoperative recommendations for health maintenance and to achieve success following weight loss surgery. This chapter will describe evidence-based comprehensive preoperative evaluation of the bariatric patient, discuss risk assessment to optimize patient selection and informed consent, and explain establishment of preoperative pathways.


Obstructive Sleep Apnea Bariatric Surgery Continuous Positive Airway Pressure Bariatric Patient Weight Loss Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Gastrointestinal Surgery for Severe Obesity. NIH Consens Statement 1991. Accessed 11 Jul 2012.
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Gupta PK, Franck C, Miller WJ, Gupta H, Forse RA. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg. 2011;212(3):301–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Flum D, Belle S, King W, Wahed AS, Berk P, Chapman W, Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.PubMedCrossRefGoogle Scholar
  5. 5.
    Finks JF, Kole KL, Yenumula PR, English WJ, Krause KR, Carlin AM, Michigan Bariatric Surgery Collaborative, from the Center for Healthcare Outcomes and Policy, et al. Predicting risk for serious complications with bariatric surgery. Ann Surg. 2011;254(4): 633–40.PubMedCrossRefGoogle Scholar
  6. 6.
    DeMaria EJ, 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;3:134–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez AZ, DeMaria EJ, Tichansky DS, Kellum JM, Wolfe LG, Meador J, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239(5):698–703.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    DeMaria EJ, Murr M, Byrne TK, Blackstone R, Grant JP, Budak A, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007;246(4): 578–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Thomas H, Agrawal S. Systematic review of obesity surgery mortality risk score – preoperative risk stratification in bariatric surgery. Obes Surg. 2012;22:1135–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Sarela AI, Dexter SP, McMahon MJ. Use of the obesity surgery mortality risk score to predict complications of laparoscopic bariatric surgery. Obes Surg. 2011;21:1698–703.PubMedCrossRefGoogle Scholar
  11. 11.
    Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease – risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Litwin SE. Which measures of obesity best predict cardiovascular risk? J Am Coll Cardiol. 2008;52:616–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Finks JF, English WJ, Carlin AM, Krause KR, Share DA, Banerjee M, Michigan Bariatric Surgery Collaborative; Center for Healthcare Outcomes and Policy, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255(6):1100–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Carmody BJ, Sugerman HJ, Kellum JM, Jamal MK, Johnson JM, Carbonell AM, et al. Pulmonary embolism complicating bariatric surgery: detailed analysis of a single institution’s 24-year experience. J Am Coll Surg. 2006;203(6):831–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Birkmeyer NJ, Share D, Baser O, Carlin AM, Finks JF, Pesta CM, Michigan Bariatric Surgery Collaborative, et al. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252(2):313–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Caruana JA, Anain PM, Pham DT. The pulmonary embolism risk score system reduces the incidence and mortality of pulmonary embolism after gastric bypass. Surgery. 2009;146:678–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Gasa M, Salord N, Fortuna AM, Mayos M, Embid C, Vilarrasa N, et al. Optimizing screening of severe obstructive sleep apnea in patients undergoing bariatric surgery. Surg Obes Relat Dis. 2013;9:539–46.Google Scholar
  18. 18.
    Piper AJ, Grunstein RR. Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med. 2011;183: 292–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, European Association for Endoscopic Surgery, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19(2):200–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Mong C, Van Dam J, Morton J, Gerson L, Curet M, Banerjee S. Preoperative endoscopic screening for laparoscopic Roux-en-Y gastric bypass has a low yield for anatomic findings. Obes Surg. 2008;18(9):1067–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002;12:634–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Korenkov M, Sauerland S, Shah S, Junginger T. Is routine preoperative upper endoscopy in gastric banding patients really necessary? Obes Surg. 2006;16(1):45–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Ghassemian AJ, MacDonald KG, Cunningham PG, Swanson M, Brown BM, Morris PG, et al. The workup for bariatric surgery does not require a routine upper gastrointestinal series. Obes Surg. 1997;7(1):16–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Fabricatore AN, Crerand CE, Wadden TA, Sarwer DB, Krasucki JL. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16(5):567–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Walfish S, Vance D, Fabricatore AN. Psychological evaluation of bariatric surgery applicants: procedures and reasons for delay or denial of surgery. Obes Surg. 2007;17:1578–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Madan AK, Tichansky DS, Taddeucci RJ. Postoperative laparoscopic bariatric surgery patients do not remember potential complications. Obes Surg. 2007;17:885–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Plerhoples TA, Lau JN. Informed consent. In: Tichansky DS, Morton J, Jones DB, editors. The SAGES manual of quality, outcomes and patient safety. New York: Springer Science + Business Media; 2012. p. 521–8.CrossRefGoogle Scholar
  28. 28.
    Ronellenfitsch U, Schwarzbach M, Kring A, Kienle P, Post S, Hasenberg T. The effect of clinical pathways for bariatric surgery on perioperative quality of care. Obes Surg. 2012;22(5):732–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of SurgeryThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Departments of Surgery and PsychiatryDuke University Medical CenterDurhamUSA

Personalised recommendations