Bariatric Times - August 2008 - (Page 13) Bariatric Times • August 2008 Spotlight 13 Bellevue bariatric operating team. The medical weight management clinic receives 20 to 30 referrals monthly, has a six-month waiting list of over 200 patients. counseling and evaluation has been provided by a nutritionist employed at Bellevue Hospital. Preoperative psychiatric evaluation has been done by an inhouse psychiatrist. We set the following guidelines to preclude adverse outcomes during the early phases of this program: • We started with laparoscopic adjustable gastric banding only because of its known safety profile.3 • We deferred surgery on the superobese (BMI>50kg/m2) since this subset has a higher overall operative risk; they are more technically challenging and have a higher likelihood of sustaining a postoperative complication.4 • We deferred patients 65 years and older. • We do not offer bariatric revision surgery during the early phases— revision surgery is also associated with a higher incidence of complications/mortality.5 • Preoperatively, all patients are placed on a very-low calorie diet (e.g. Optifast) to decrease hepatomegaly and to make the surgery less technically demanding.6 • Two laparoscopic/bariatric fellowship-trained attendings have been scrubbed on all cases to minimize operative complications. • We created a dedicated bariatric anesthesia team and anesthesia clinical pathway to standardize intraoperative and perioperative care for the bariatric patient. • We created a dedicated OR team (i.e. scrub techs and circulators) and have identified one operating room where these procedures take place. • We created a clinical pathway to facilitate the standardization of perioperative care, including sending all patients to a monitored setting the first postoperative night. • We have 24-hour access to a full complement of various consultative services required for the care of the bariatric surgical patient, including round-the-clock availability of an inhouse surgical attending physician (since Bellevue Hospital is a Level 1 Trauma Center). • We have a full-time SICU staff with extensive experience managing critically ill, morbidly obese patients with ventilators and invasive hemodynamic monitoring technologies. We successfully performed the first laparoscopic bariatric surgery at Bellevue Hospital in January 2008. Approximately 20 cases have been done in the first three months. Our first bariatric support group met in March 2008. In order to create a bona fide comprehensive center, the Medical Weight Management Clinic and the Bariatric Surgery Clinic are in the process of merging. Furthermore, we are working closely with the hospital’s department of psychiatry to integrate behavioral therapy and psychotherapy into our postoperative support groups. The research opportunities from this endeavor are unparalleled. Our research focus will include diabetes/metabolic disease resolution and obesity outcomes for different therapies (surgical/nonsurgical). The even- Bellevue bariatric outpatient team. http://www.newdirectionsystem.com http://www.newdirectionsystem.com
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