Skip to main content
SpringerLink
Log in

Patient Assessment and Post-op Management from the Physician’s Point of View

  • Chapter
  • First Online:
The Globesity Challenge to General Surgery

  • 681 Accesses

Abstract

Obesity is frequently associated with metabolic, cardiovascular, and respiratory comorbidities that may significantly increase the risk of perioperative complications in general as well as in bariatric surgery. In elective surgery, patient assessment should include a careful evaluation of comorbidities status, in particular regarding the presence of type 2 diabetes, hypertension, and sleep-related disturbances of breathing. Ideally, a good metabolic control should be achieved before surgery in patients with overt type 2 diabetes, and a tight control of blood pressure levels should be obtained in hypertensive subjects. Patients with moderate-to-severe sleep apnea syndrome requiring nocturnal ventilation should be adapted to the ventilator before surgery and should continue the ventilation therapy in the perioperative period. A brief course of weight loss with a very low-calorie diet should be considered at least in patients with severe obesity and high-risk comorbidities. Even a moderate or partial body weight reduction has been demonstrated to have a significant impact on comorbidities status and severity in morbid obese patients. In the early postoperative period, a strict control of glucose levels is mandatory both in patients with and without diabetes, given the high frequency of stress-related hyperglycemia and its negative impacts of general prognosis . Careful observation and control of comorbidities is warranted in all patients in the postoperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I (2007) Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 142:621–635

    Article  PubMed  Google Scholar 

  2. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454

    Article  Google Scholar 

  3. De Maria EJ, Murr MM, Byrne TKM et al (2007) Validation of the obesity surgery mortality score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg 346:578–584

    Google Scholar 

  4. Blackstone RP, Cortés MC (2010) Metabolic acuity score: effect on major complications after bariatric surgery. Surg Obes Relat Dis 6:267–273

    Article  PubMed  Google Scholar 

  5. Mechanick JI, Youdim A, Jones DB et al (2013) 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 21:S1–S27

    Article  PubMed  CAS  Google Scholar 

  6. Moghissi ES (2010) Addressing hyperglycemia from hospital admission to discharge. Curr Med Res Opin 26:589–598

    Article  PubMed  CAS  Google Scholar 

  7. Moghissi ES, Korytkowski MT, DiNardo M et al (2009) American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 32:1119–1131

    Article  PubMed Central  PubMed  Google Scholar 

  8. Dronge AS, Perkal MF, Kancir S et al (2006) Long-term glycemic control and postoperative infectious complications. Arch Surg 141:375–380

    Article  PubMed  Google Scholar 

  9. Estrada CA, Young JA, Nifong LW et al (2003) Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg 75:1392–1399

    Article  PubMed  Google Scholar 

  10. Pomposelli JJ, Baxter JK III, Babineau TJ et al (1998) Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr 22:77–81

    Article  CAS  Google Scholar 

  11. Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367

    Article  PubMed  Google Scholar 

  12. Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461

    Article  PubMed  Google Scholar 

  13. Finfer S, Chittock DR, Su SY et al (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297

    Article  PubMed  Google Scholar 

  14. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM (1999) Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg 89:814–822

    Article  PubMed  CAS  Google Scholar 

  15. Mortazavi SMJ, Kakli H, Bican O, Moussouttas M, Parvizi J, Rothman RH (2010) Perioperative stroke after total joint arthroplasty: prevalence. Predictors and outcome. J Bone Joint Surg Am 92:2095–2101

    Article  PubMed  Google Scholar 

  16. Weksler N, Klein M, Szendro G et al (2003) The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery? J Clin Anesth 15:179–183

    Article  PubMed  Google Scholar 

  17. Fleisher LA, Beckman JA, Brown KA et al (2007) A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary. J Am Coll Cardiol 50:1707–1732

    Google Scholar 

  18. Comfere T, Sprung J, Kumar MM et al (2005) Angiotensin system inhibitors in a general surgical population. Anesth Analg 100:636–644

    Article  PubMed  Google Scholar 

  19. Bertrand M, Godet G, Meersschaert K, Brun L, Salcedo E, Coriat P (2001) Should the angiotensin II antagonists be discontinued before surgery? Anesth Analg 92:26–30

    Article  PubMed  CAS  Google Scholar 

  20. Sareli AE, Cantor CR, Williams NN et al (2009) Obstructive sleep apnea in patients undergoing bariatric surgery — a tertiary center experience. Obes Surg 21:316–327

    Article  PubMed  Google Scholar 

  21. Rasmussen JJ, Fuller WD, Ali MR (2012) Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis 5:569–573

    Article  Google Scholar 

  22. Gupta RM, Parvizi J, Hanssen AD et al (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case control study. Mayo Clin Proc 76:897–905

    Article  PubMed  CAS  Google Scholar 

  23. Liao P, Yegneswaran B, Vairavanathan S et al (2009) Postoperative complications in patients with obstructive sleep apnea: a restrospective matched cohort study. Can J Anaesth 56:819–828

    Article  PubMed  Google Scholar 

  24. Chung F, Yegneswaran B, Liao P et al (2008) Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108:822–830

    Article  PubMed  Google Scholar 

  25. Chung F, Subramanyan R, Liao P et al (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108:768–775

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  26. Kolotkin RL, LaMonte MJ, Walker JM, Cloward TV, Davidson LE, Crosby RD (2011) Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis 7:605–610

    Article  PubMed Central  PubMed  Google Scholar 

  27. Dixon JB, Schachter LM, O’Brien PE (2003) Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest 123:1134–1141

    Article  PubMed  Google Scholar 

  28. Nepomnayshi D, Hesham W, Erickson B, MacDonald J, Iorio R, Brams D (2013) Sleep apnea: is routine preoperative screening necessary? Obes Surg 23:28791

    Google Scholar 

  29. Chiumello D, Chevallard G, Gregoretti C (2011) Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med 37:918–929

    Article  PubMed  CAS  Google Scholar 

  30. Ramirez A, Lalor PF, Szomstein S et al (2009) Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux- en-Y gastric bypass: is it safe? Surg Obes Relat Dis 5:544–546

    Article  PubMed  Google Scholar 

  31. Fris RJ (2004) Preoperative low energy diet diminishes liver size. Obes Surg 14:1165–1170

    Article  PubMed  Google Scholar 

  32. Edholm D, Kullberg J, Haenni A et al (2011) Preoperative 4-week low- calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg 21:345–350

    Article  PubMed  Google Scholar 

  33. Lewis MC, Phillips ML, Slavotinek JP et al (2006) Change in liver size and fat content after treatment with Optifast® very low calorie diet. Obes Surg 16:697–701

    Article  PubMed  Google Scholar 

  34. Frutos MD, Morales MD, Luján J et al (2007) Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg 17:150–154

    Article  PubMed  Google Scholar 

  35. Busetto L, Enzi G, Inelmen EM et al (2005) Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon. Chest 128:618–623

    Article  PubMed  Google Scholar 

  36. Handelsman Y, Mechanick JI, Blonde L et al (2011) American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 17(Suppl 2):1–52

    Article  PubMed  Google Scholar 

  37. Busetto L, Segato G, De Luca M et al (2004) Pre-operative weight loss by intragastric balloon in super obese patients treated with laparoscopic gastric banding: a case–control study. Obes Surg 14:671–676

    Article  PubMed  Google Scholar 

  38. Alami RS, Morton JM, Schuster R et al (2007) Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis 3:141–146

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy

    Luca Busetto & Fabio De Stefano

Authors
  1. Luca Busetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio De Stefano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Busetto .

Editor information

Editors and Affiliations

  1. Clinica Chirurgica 1, Università degli Studi di Padova, Padova, Padova, Italy

    Mirto Foletto

  2. Department of General Surgery, Cleveland Clinic Florida, Weston, Florida, USA

    Raul J. Rosenthal

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Busetto, L., De Stefano, F. (2014). Patient Assessment and Post-op Management from the Physician’s Point of View. In: Foletto, M., Rosenthal, R. (eds) The Globesity Challenge to General Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5382-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5382-3_4

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5381-6

  • Online ISBN: 978-88-470-5382-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation