Management Of Bariatric Surgery Patients Research Articles

Analysis of the Relationship between Physical Activity and the Factors Related to Weight Management of Bariatric Surgery Patients.

We aimed to analyze the relationship between physical activity and the factors related to the weight management of bariatric surgery patients. This descriptive-correlational study was conducted on 87 participants, who underwent bariatric surgery in Cyprus between May and Oct 2020. The International Physical Activity Questionnaire and a questionnaire on socio-demographic and obesity characteristics were used to collect data. Mean age of the participants was 34.7±8.43 and 65.5% were female. A statistically significant difference was found between physical activity levels and weight loss (P=0.021). Post-bariatric surgery physical activity level was low active for 65.5% of the participants. There was a statistically significant difference between the MET scores of the participants according to their gender, and the scores of men were higher than women (2256.9; 1110.9 respectively). Although most of the participants in the study were females, women lost less weight than males (45.5; 54.2 respectively). Being female, married, and having chronic diseases caused less weight loss after bariatric surgery. As the physical activity levels of the patients increased, their weight loss increased. In line with these results, people undergone bariatric surgery and are at risk of regaining weight should be followed closely after surgery and appropriate physical activities should be planned.

Nurse-led intervention for the management of bariatric surgery patients: A systematic review.

The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.

How Effective Is the Multidisciplinary Team Approach in Bariatric Surgery?

Multidisciplinary team (MDT) meetings are widely recommended in the management of bariatric surgery patients; however, there is limited evidence for their effectiveness. The aims of this study were to evaluate the decision-making process of a single-day bariatric MDT clinic and secondly to evaluate whether these MDT decisions were implemented. This was a retrospective observational study analysing MDT treatment decisions from February 2012 to June 2013 using an MDT proforma. The decision-making process of the MDT meeting was investigated by assessing the alterations in management plan between the surgeon and the rest of the MDT. Adherence to MDT decisions was also assessed. Decisions regarding 200 consecutive patients were analyzed. There was MDT agreement for 55%, and patients were listed for surgery on the day of the MDT. There was MDT disagreement regarding 45%, with conflicting opinions expressed by surgeons in 33/200 (17%), anaesthetists in 60/200 (30%) and dieticians in 65/200 (33%). The MDT plan was instigated in 78% and the most common reason for failure was patients failing to attend for further assessment. By the end of the study, 85% of patients underwent bariatric surgery, 11.5% declined further input, 2.5% chose further weight loss and 1% were removed from waiting list. Use of a single-day MDT clinic format resulted in a change in plan for a significant number of patients. This can be interpreted as improved quality of care for these patients, and we conclude the MDT approach is valuable.

A418 - The Integration of Medical, Psychological, and Quality of Life Measures in the Prediction and Maintenance of Excess Weight Loss after Bariatric Surgery

Background: The National Institute of Health, the American Association of Clinical Endocrinologists, the American Society for Metabolic and Bariatric Surgery, and the Obesity Society Guidelines for the Clinical Management of Bariatric Surgery patients have long recommended that assessment of bariatric surgery candidates include presurgical psychological evaluations as a national standard practice amongst bariatric centers.

NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity.

Despite increasing prevalence of obesity, no country has successfully implemented comprehensive pathways to provide advice to all the severely obese patients that seek treatment. We aimed to formulate pathways for referral into and out of weight assessment and management clinics (WAMCs) that include internal medicine/primary care physicians as part of a multidisciplinary team that could provide specialist advice and interventions, including referral for bariatric surgery. Using a National Institute of Health and Care Excellence (NICE)-accredited process, a Guidance Development Group conducted a literature search identifying existing WAMCs. As very few examples of effective structures and clinical pathways existed, the current evidence base for optimal assessment and management of bariatric surgery patients was used to reach a consensus. The model we describe could be adopted internationally by health services to manage severely obese patients.

A118 - Do Findings on Routine Preoperative Egd Alter Our Management of Bariatric Surgery Patients?

was significant difference between baseline values of leptin, with higher levels in group B (p 1⁄4 0.02). Conclusions: The secretion profile of gastrointestinal hormones in patients with weight regain after RYGP is different from patients with satisfactory post-operative weight outcome. After meal stimulation, reduced levels of GIP and GLP-1 may indicate influence of intestinal hormonal secretion in the process of weigh regain. Profile secretion of ghrelin was similar, and leptin increased indicates a higher fat accumulation in the weight regained group.

Assessment and management of bariatric surgery patients

Assessment and management of bariatric surgery patients

A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002-2013.

The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults. This review included 15 studies published between 2002 and 2013. Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive. The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.

The bariatric multi-disciplinary team meeting: A useful resource or a source of delay?

s / International Journal of Surgery 12 (2014) S13eS117 S99 0224: AUDIT OF CLINICAL CODING ACCURACY FOR LAPAROSCOPIC CHOLECYSTECTOMY e ROOM FOR IMPROVEMENT? KellyHaldane, Yik L. Pang, EmmaL. Court .North Bristol NHS Trust, Bristol, UK. Introduction: Accurate clinical codingensures correct remuneration through Payment by Results. Data quality depends upon comprehensive clinical notes for each admission. This study aimed to identify clinical coding errors for patients undergoing laparoscopic cholecystectomy in our NHS Trust. Methods: Notes of 19 consecutive elective and 18 emergency laparoscopic cholecystectomy patients (15M, 22F, range 25-79 years) across two hospitals were retrospectively reviewed. Operations, procedures and co-morbidities detailed in notes for the laparoscopic cholecystectomy admission were recorded. Clinical coding data for each admission was obtained from Coding and IT Departments. The two data sets were then compared. Results: Recording of operations/procedures performed was correct in all 37 cases. Co-morbidity coding data omissions among the elective cohort was 9/19 cases (47.4%) and 8/18 (44.4%) emergency cases. The commonest omissions were cardiovascular disease, respiratory disease, gastrointestinal disease and obesity. There were no diabetic coding errors. The payment deficit for incorrect coding was £3087.58. Conclusions: The accuracy of operation/procedural codings in our study may be linked to the WHO theatre checklist, which verifies the procedure name. However, accuracy of co-morbidity coding data was poor. We recommend clinical coding education sessions for doctors and introduction of a mandatory co-morbidities section in the electronic discharge summary programme. 0479: THE BARIATRIC MULTI-DISCIPLINARY TEAM MEETING: A USEFUL RESOURCE OR A SOURCE OF DELAY? Naomi Bullen , Jeremy Gilbert, Michael Clarke, Allwyn Cota, Ian Finlay. Royal Cornwall Hospitals Bariatric and Metabolic Surgery Unit, Truro, UK. Introduction: Multi-Disciplinary Team meetings (MDT) are recommended for management of bariatric surgery patients despite limited evidence for their effectiveness. This study assessed the impact of the MDT upon patient care decisions and delays in treatment. Methods: A retrospective case note analysis of MDT decisions between Feb 2012 July 2013 was performed. PreMDTopinions of surgeon, anaesthetist and dieticianwere compared with subsequent MDT decisions. Consequent delays to treatment were also recorded. Results: 200 patient's notes were analysed. Pre MDT opinions by the surgeons were that 176/200 (88%) patients should proceed to surgery and 24 (12%) required further investigation. There was MDT agreement in 115/ 176 (65.3%) but disagreement in 61/176 (34.7%). In 34/176 (19.3%) anaesthetist opinion differed, and in 55/176 (31.2%) dietician’s opinion differed. Mean delays to treatment resulting from MDT inspired interventions / investigations were 95 days. Conclusions: The MDT approach resulted in a change in decision for a significant number of patients (34.7%). This can be interpreted as resulting in improved quality of care for these patients however this was at the expense of a mean 95 days delay to treatment. We conclude that the MDT approach is clinically valuable, and have identified areas for reducing subsequent delays. 0483: CAN WE ACCEPT LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) AS A SINGLE STAGE BARIATRIC PROCEDURE? A SYSTEMATIC REVIEW Ahmed Ahmed , Mohamed Eltom, Bijendra Patel. Barts Cancer Institute,

Perioperative management of bariatric surgery patients.

The perioperative management of bariatric surgery patients is described. Obesity and anatomical changes create unique challenges for clinicians when caring for bariatric surgery patients. Common bariatric surgery procedures performed include Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Pain management in the acute postoperative period depends on careful dosing of opioid agents and the use of adjunctive agents. Prevention and management of infectious complications include appropriate surgical prophylaxis, monitoring and rapid treatment of suspected intra-abdominal infections, and detection and treatment of Helicobacter pylori infection. Venous thromboembolism (VTE) prophylaxis and treatment are complicated by obesity, and the use of pharmacologic agents must be balanced with bleeding risk. Bleeding is a serious complication that should be closely monitored in the immediate postoperative period. Blood products remain first-line therapy for the treatment of bleeding in this population. Acute differences in drug absorption as well as emerging hormonal changes necessitate the immediate postoperative adjustment of chronic medications to ensure both safety and efficacy. Pharmacists are valuable members of interprofessional teams for bariatric surgery patients because they provide expertise on the availability of dosage forms and dosage modification to ensure that patient pharmacotherapy is not interrupted; assist in the management of hypertension, diabetes, and psychotropic medications; and ensure appropriate antimicrobial prophylaxis and VTE prophylaxis and treatment dosages. The management of patients in the perioperative period of bariatric surgery requires appropriate selection and dosing of medications for pain management and treatment of infectious complications, VTE, bleeding, and other chronic diseases.

Role of endoscopy in the bariatric surgery of patients.

Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett's esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett's esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.

Beyond Numbers: Improving Nutritional Management of Bariatric Surgery Patients Through Improved Intake, Counseling and Physical Diagnosis

Surgery is considered the most effective intervention for obesity to date offering significantly improved health through the management of weight, obesity-related co-morbidities and enhanced quality of life. The number of obese individuals who have chosen to undergo surgical interventions has been steadily rising. As such, in/outpatient dietetic practitioners operating in the bariatric scope are facing high volume census numbers and fast-paced environments. Clinicians must be equipped with the competency and tools to efficiently manage bariatric patients in all stages of their journey. This workshop stresses the idea that good nutritional care starts at the beginning of a patient’s journey and cannot depend on biochemical indices alone. Therefore, in addition to laboratory medicine, we will explore effective counseling strategies and bariatric best practices, how to optimize clinician interview techniques and streamline the intake process using ‘red flag’ references and screening tools that review critical anthropometric, clinical and dietary questions needed to identify manifestations of potential problems all of which can be promptly implemented in the clinical setting to support clinician aptitude and efficiency, as well as favorable long-term patient outcomes.

Obesity education for nurse practitioners: Perspectives from nurse practitioner faculty

The purpose of the study was to investigate curriculum content and teaching practices about obesity in graduate nursing programs in the United States. A survey of 1202 faculty members teaching in nurse practitioner (NP) programs was conducted using an investigator-created instrument with items based on the National Institutes of Health Obesity Education Initiative guidelines. Objective items were analyzed using descriptive and nonparametric statistics, and the open-ended questions were analyzed using content analysis. NP faculty emphasized existing clinical practice guidelines, but revealed a large disparity between what is emphasized in schools of nursing and the state of the science regarding obesity etiology and management. Faculty place a priority on teaching obesity as a key factor in the development of comorbidities, and weight loss as a means of treating these comorbidities. Teaching about the pathophysiology of obesity, management of bariatric surgery patients, and pharmacologic therapy are de-emphasized. Four main themes about obesity teaching practices were identified from subjects' comments to open-ended items. Additional education and support are needed for faculty to teach about obesity in a way that advances the care of obese patients based on emerging scientific principles.

Perioperative management of bariatric surgery patients: Focus on metabolic bone disease

Chronic vitamin D deficiency, inadequate calcium intake, and secondary hyperparathyroidism are common in obese individuals, placing them at risk for low bone mass and metabolic bone disease. After bariatric surgery, they are at even higher risk, owing to malabsorption and decreased oral intake. Meticulous preoperative screening, judicious use of vitamin and mineral supplements, addressing modifiable risk factors, and monitoring the absorption of key nutrients postoperatively are essential in preventing metabolic bone disease in bariatric surgery patients.

Wernicke’s Syndrome after Sleeve Gastrectomy

We report a case of Wernicke's encephalopathy after sleeve gastrectomy, which had been complicated by stomach wall edema and aggravated by dietary non-compliance. Despite intense parenteral nutrition, thiamine deficiency became clinically evident. It suggests that nutritional preparations used were unable to cover the increased thiamine requirement. After intense thiamine supplementation, gradual improvement occurred during the 6 months after the diagnosis, without permanent cognitive impairment. Clinicians involved in postoperative management of bariatric surgery patients must consider Wernicke's syndrome in hyper-emetic patients, who show unclear neurological deterioration. Early diagnosis and treatment can instantly improve the patient's condition without permanent sequelae.