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CEL Online - Perioperative Care of the Bariatric Surgery Patient

Intro to the Guidelines and Pertinent Literature

Highland Hospital
Department of General and Bariatric Surgery

Date of Release

August 13, 2015

Period of Validity

August 13, 2015 - August 13, 2016

Educational Need

As a result of the increased rates of obesity and the increased need for bariatric surgery, primary care providers (PCPs) as well as other specialty providers are likely to encounter patients who have undergone bariatric surgery. Additionally PCP's are often the first medical professionals that patients seek out for questions and concerns about their surgery. Literature suggests that providers lack confidence in their knowledge of perioperative care of bariatric surgery patients.

Providers are often unfamiliar with the following:

  • Types of bariatric procedures
  • Unique complications that patients may experience
  • Pre-op evaluation, requirements
  • Post-op care
  • Drug contraindications after bariatric surgery
  • Common nutritional deficiencies

Patients are encouraged to have yearly follow up visits with their surgery center. However, many patients are lost to follow up. These patients are at particular risk for nutritional deficiencies and less than efficient evaluation and management of patient GI complaints such as abdominal pain, nausea, vomiting, diarrhea.

This program is designed to educate providers with the various bariatric surgery procedures and to also assist providers with identifying and managing complications related to bariatric surgery.

Learning Objectives

After viewing this module participants should be able to:
Identify and discuss pre-operative requirements for bariatric surgery
Identify and discuss common complications following bariatric surgery
Identify and discuss post-operative care needs of bariatric surgery patients

Bibliographic Sources to Allow for Further Study

American Medical Association (2013). AMA Adopts New Policies on Second Day of Voting at Annual Meeting. Retrieved from:  ama-assn.org

Birkmeyer, J. D., Finks, J. F., O'Reilly, A., Oerline, M., Carlin, A. M., Nunn, A. R., Dimick, J., Banerjee, M., Birkmeyer, N. J. & Michigan Bariatric Surgery Collaborative (2013). Surgical skill and complication rates after bariatric surgery. New England Journal of Medicine. 369(15):1434-42. doi: 10.1056/NEJMsa1300625.

Centers for Medicare and Medicaid Services (2006). Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R). Retrieved from:   http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=160&ver=32&NcaName=Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity+(1st+Recon)&bc=BEAAAAAAEAgA

Centers for Medicare and Medicaid Services (2012). Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). Retrieved from:http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=258&fromdb=true

Centers for Disease Control and Prevention (2014). Overweight and Obesity. Retrieved from: http://www.cdc.gov/obesity/data/adult.html

Chang, S., Stoll, C. R. T., Song, J., Varela, J. E. , Eagon, C. J., Colditz, G. A. (2014). The Effectiveness and Risks of Bariatric Surgery:  An Updated Systematic Review and Meta-analysis, 2003-2012. JAMA Surgery. 149(3):275-287. doi:10.1001/jamasurg.2013.3654

Deveney, C. W., MacCabee, D., Marlink, K., Welker, K., Davis, J., & McConnell, D. B. (2004). Scientific paper: Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity. The American Journal Of Surgery, 187(Papers of the North Pacific Surgical Association), 655-659. doi:10.1016/j.amjsurg.2004.01.001

Dixon, J. B. (2008). Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes. Journal of the American Medical Association. 299(3):316-323.
Finklestein, E. A. Trogdon, J. G., Cohen, J. W., et al (2009). Annual medical spending attributable to obesity: payer and service specific estimates. Health Affairs. 28, 822-831.

Foster-Schubert, C. E. (2011). Hypoglycemia complicating bariatric surgery: incidence and Mechanisms. Current Opinion in Endocrinology, Diabetes and Obesity. 18(2): 129–133. doi:10.1097/MED. 0b013e32834449b9.

Griffith, P. S., Birch, Daniel W,M.Sc, M.D., Sharma, Arya M,M.D., PhD., & Karmali, S., M.D. (2012). Managing complications associated with laparoscopic roux-en-Y gastric bypass for morbid obesity. Canadian Journal of Surgery, 55(5), 329-36. Retrieved from http://search.proquest.com/docview/1086344193?accountid=27700

Hamdan K, Somers S, Chand M. Management of late postoperative complications of bariatric surgery. British Journal Of Surgery [serial online]. October 2011;98(10):1345-1355. Available from: Academic Search Complete, Ipswich, MA. Accessed January 12, 2015.

Jia H and Lubetkin EI. (2010) Trends in quality-adjusted life-years lost contributed by smoking and obesity. American Journal of Preventive Medicine 2010;38(2):138-144.

Kaplan, L. M. (2005). Gastrointestinal management of the bariatric surgery patient. Gastroenterology Clinics of North America. 34(1):105-25.

Mechanick, J. I., Youdim, A., Jones, D. B., Timothy Garvey, W., Hurley, D. L., Molly McMahon, M., & ... Brethauer, S. (2013). AACE/TOS/ASMBS Guidelines: 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. Surgery For Obesity And Related Diseases, 9159-191. doi:10.1016/j.soard.2012.12.010

Moon, R. C., Teixeira, A. F., Goldbach, M., Jawad, M. A. (2014). Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surgery for Obesity and Related Diseases. 10(2):229-34. doi: 10.1016/j.soard.2013.10.002.

Office of the State Comptroller (2012). Report: Soaring Health Care Costs Highlight Need To Address Childhood Obesity One in Three New York Children Are Overweight or Obese. Oct 12, 2012. Retrieved from: http://www.osc.state.ny.us/press/releases/oct12/102412.htm

Puzziferri, N., Roshek, T. B., Mayo, H. G., Gallagher, R., Belle, S. H., & Livingston, E. H. (2014). Long-term follow-up after bariatric surgery:  A systematic review. JAMA. 312(9):934-942. doi:10.1001/jama.2014.10706.
Ryan, D.H., Johnson, W.D., Myers, V.H., et al. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. Archives of Internal Medicine 170(146–154)

Tack, J., Arts ,J., Caenepeel, P., DeWulf, D., Bisschops, R. (2009). Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. (10):583e90.

U.S. Food and Drug Administration (2014) . Medical devices. Gastric banding. Retrieved from: http://www.fda.gov/medicaldevices/productsandmedicalprocedures/obesitydevices/ucm350132.htm#eligibility

U.S. National Library of Medicine. (2012). Roux-en-Y stomach surgery for weight loss Laparoscopic Roux-en-Y Gastric Bypass. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19268.htm

Vage V, Nilsen R, Mellgren G, et al. Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS). Obesity Surgery [serial online]. January 2013;23(1):80-86. Available from: MEDLINE, Ipswich, MA. Accessed December 30, 2014.

Weight Control Information Network (2014). Do You Know Some of the Health Risks of Being Overweight?. Retrieved from: http://www.win.niddk.nih.gov/publications/health_risks.htm

Helpful Links

The American Society for Metabolic and Bariatric Surgery (ASMBS)
https://asmbs.org/

Obesity Action Coalition
http://www.obesityaction.org/obesity-treatments/bariatric-surgery

Bariatric Surgery Center at Highland Hospital – Physicians Resource
https://www.urmc.rochester.edu/highland/bariatric-surgery-center/Physicians-Resource.aspx

Bariatric Surgery Center at Highland Hospital
https://www.urmc.rochester.edu/highland/bariatric-surgery-center.aspx

Summary of Clinical Practice Guidelines

 

Accreditation

The University of Rochester School of Medicine & Dentistry is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians.

Certification

The University of Rochester School of Medicine and Dentistry designates this enduring material for a maximum of 0.5 AMA PRA Category Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity

Nursing Continuing Education Contact Hours

This activity has been submitted to the Pennsylvania State Nurses Association for approval to award contact hours. The Pennsylvania State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

SCS Disclosure Statement

ACCME Standards of Commercial Support (SCS) of CME require that presentations be free of commercial bias and that any information regarding commercial products/services be based on scientific methods generally accepted by the medical community.  When discussing therapeutic options, faculty are requested to use only generic names.  If they use a trade name, then those of several companies should be used.  If a presentation includes discussion of any unlabeled or investigational use of a commercial product, faculty are required to disclose this to the participants.

Planning Committee and Author/Speaker Declarations

The ACCME Standards of Commercial Support require that presentations be free of commercial bias and that any information regarding commercial products/services be based on scientific methods generally accepted by the medical community. All of the planning committee members (listed here) have declared that they have no financial interests or relationships to disclose: Elizabeth Hughes, FNP

The following authors/speakers have disclosed financial interests/arrangements or affiliations with organizations that could be perceived as real or apparent conflict of interest in the context of the subject of their presentation(s).  Only the current arrangements/interests are included:

Elizabeth Hughes, FNP has no financial interests or relationships to disclose.

No commercial funds have been received to support this educational activity

Contact Information

For questions regarding certification or credit reports:
University of Rochester Medical Center
Center for Experiential Learning
Phone: (585) 275-7666
E-Mail: cmeoffice@urmc.rochester.edu

Registration Fees:


URMC Physician

$15.00

URMC Non-Physician

$10.00

Non-URMC Physician

25.00

Non-URMC / Non-Physician

$15.00

This Course is No Longer Available

Criteria for successful completion of this activity include

  • Review the webcast
  • Completion of  the self-assessment / program evaluation*

*The self-assessment / program evaluation must be completed in one sitting.

Certificates

  • Will be available for download immediately following completion of the program evaluation.
  • Participants must download and save or print certificates before exiting the course.
  • Please remember to send a copy of your certificate to your credentialing office and to keep a copy for your records.