Best Practice Updates for Multidisciplinary Care in Weight Loss Surgery

Abstract

IntroductIonEvidence-based best practice guidelines for multidisciplinary care in weight loss surgery (WLS) have been previously described (1). Earlier recommendations focused on patient selection/screening, operative risk, medical evaluation, nutrition counseling, and postoperative care (2). This report covers key updates in these and other areas.Because extreme obesity can potentially affect all organ systems and psychological health (3), optimal surgical treatment of WLS requires communication and collaboration among a multidisciplinary team of caregivers. This article establishes the most current best practice guidelines for multidisciplinary care, with a focus on long-term outcomes and patient safety. Methods And ProceduresWe searched MEDLINE and the Cochrane Library for articles published on WLS and patient selection, medical, multidisciplinary, and nutritional care published between April 2004 and April 2007. The system used to grade the quality of the evidence has already been described (1). We identified >150 papers; the 112 most relevant were reviewed in detail. These included randomized controlled trials, prospective and retrospective cohort studies, meta-analyses, case reports, prior systematic reviews, and expert opinion. The focus of the recommendations and the process used to develop them are reported elsewhere (1). results Multidisciplinary careIn February 2006, the Centers for Medicare and Medicaid Services decided to cover WLS performed at accredited facilities, such as Centers of Excellence (4). These are defined as facilities that meet standards of multidisciplinary care set by the American Society for Metabolic and Bariatric Surgery (4) and the American College of Surgeons (5).However, existing guidelines on multidisciplinary care are vague. The 1991 National Institutes of Health consensus report on Gastrointestinal Surgery for Severe Obesity recommended multidisciplinary teams with medical, surgical, psychiatric, and nutritional expertise (6). Based on results from a national survey, 93% of respondents used a multidisciplinary approach to treat WLS patients, but only 53% had the National Institutes of Health-recommended team, and only 47% required the National Institutes of Health-recommended evaluations (7). The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence-based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New reco...

Bariatric Surgery and Cardiovascular Risk Factors

“…The diet after weight loss surgery is based on a strong emphasis on texture. 177,178 The purely restrictive procedures, LABG and the vertical sleeve gastrectomy, do not alter food pathway and affect nutritional status only by virtue of restricting overall caloric intake. Because the bypass procedures alter food pathway, there are significant effects on the absorption of micronutrients, and a lifelong regimen of daily supplementation of vitamins and minerals is essential.…”

Vitamin D alteration associated with obesity and bariatric surgery

“…The risk of fracture after bariatric surgery remains a matter of controversy; a study showed twice the risk in patients who have had bariatric surgery compared to the rates of incidence based on the general population, 97 the other study showing no increase of the risk of fracture in the first two years after surgery compared to a non-operated obese population. 98 There are very many recent recommendations in clinical practice focusing on patients treated with bariatric surgery 84,99,100 (Table 1). While these recommendations are the subject of extreme care by their authors using all of the relevant and available data literature, certain recommended measures are not always based on medical data [101][102][103] A randomized study showed that taking 50,000 IU ergocalciferol weekly gave at one year higher values of 25-hydroxy vitamin D than in the daily intake of 800 IU.…”

Physiologic changes in obesity and patient preparation for bariatric surgery

“…[55] Therefore, preoperative evaluation of the patient should be thorough and include full psychiatric screening, personality analysis and surveillance for substance abuse, and furthermore, patient education is mandatory for postoperative period. [56,57] Any maladaptive eating patterns should be treated and counselled for the success of bariatric surgery.…”