Medical Management Before Bariatric Surgery

AbstractPurpose of ReviewThe evaluation of patients before bariatric surgery requires identification and optimization of the known comorbidities associated with obesity. Evaluation begins with cardiac and pulmonary assessment for elective noncardiac surgery for patients with severe obesity published inCirculation in 2009 by the AHA.1 The algorithm uses a 5-step approach and evaluation after a comprehensive history and physical exam and lab testing completed.Recent FindingsA standardized preoperative checklist and Clinical Practice Guidelines were updated in 2013 by the American Associations of Clinical Endocrinologists (ACCE), The Obesity Society (TOS), and the American Society for Metabolic and Bariatric Surgery (ASMBS). The Clinical Practice Guidelines have 74 recommendations for the preoperative evaluation of the bariatric surgery patient including lab testing, nutritional screening, endocrine evaluation, and the cardiopulmonary evaluation including sleep apnea screening. During the medical evaluation usually within 2 –4 weeks before bariatric surgery, the use of an additional algorithm from the AHA/ACC utilizes a 7-step algorithm to determine a patient’s functional capacity, cardiopulmonary risk, and the need for further cardiac evaluation to include stress testing, cardiology, or pulmonary evaluation.SummaryIn summary, utilization of the AHA science advisory cardiac and pulmonary assessment of the patient with severe obesity before bariatric surgery is extremely hel...

Source: Current Cardiovascular Risk Reports - January 26, 2020 Category: Cardiology Source Type: research