AORN Journal
Volume 88, Issue 1 , Pages 30-58 , July 2008

Perioperative Nursing Care of the Bariatric Surgical Patient

  • Patricia Ide, RN, MS, CNOR

      Affiliations

    • Patricia Ide, RN, MS, CNOR, is a staff nurse at Brigham and Women's Hospital, Boston, MA. Ms Ide has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.
    • ,
  • Elliott S. Farber, MD

      Affiliations

    • Elliott S. Farber, MD, is a staff anesthesiologist and clinical instructor at Brigham and Women's Hospital. Dr Farber has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.
    • ,
  • David Lautz, MD

      Affiliations

    • David Lautz, MD, is the medical director for bariatric surgery at Brigham and Women's Hospital. Dr Lautz has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.

References 

  1. Ogden CL , Carroll MD , Curtin LR , McDowell MA , Tabak CJ , Flegal KM . Prevalence of overweight and obesity in the United States, 1999–2004 . JAMA . 2006;295(13):1549–1555
  2. Hedley AA , Ogden CL , Johnson CL , Carroll MD , Curtin LR , Flegal KM . Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002 . JAMA . 2004;291(23):2847–2850
  3. Mokdad AH , Marks JS , Stroup DF , Gerberding JL . Actual causes of death in the United States, 2000 . JAMA . 2004;291(10):1238–1245
  4. Clegg A , Colquitt J , Sidhu M , Royle P , Walker A . Clinical and cost-effectiveness of surgery for morbid obesity: a systematic review and economic evaluation . Int J Obes Relat Metab Disord . 2003;27(10):1167–1177
  5. Statistics related to overweight and obesity. US Department of Health and Human Services. Weight-Control Information Network . http://win.niddk.nih.gov/statistics/index.htm Accessed May 20, 2008.
  6. Christou NV , Sampalis JS , Liberman M , et al.   Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients . Ann Surg . 2004;240(3):416–423
  7. Brolin RE . Bariatric surgery and long-term control of morbid obesity . JAMA . 2002;288(2):2793–2796
  8. Buchwald H , Avidor Y , Braunwald E , et al.   Bariatric surgery: a systematic review and meta-analysis . JAMA . 2004;292(14):1724–1737
  9. Bariatrics . In: Stedman's Medical Dictionary . 28th ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2006;p. 203
  10. Smoot TM , Xu P , Hilsenrath P , Kuppersmith NC , Singh KP . Gastric bypass surgery in the United States, 1998–2002 . Am J Public Health . 2006;96(7):1187–1189
  11. Santry HP , Gillen DL , Lauderdale DS . Trends in bariatric surgical procedures . JAMA . 2005;294(15):1909–1917
  12. CMS Manual System. Pub 100-03. Medicare National Coverage Decisions. Transmittal 54. Bariatric surgery for treatment of morbid obesity. Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov/Transmittals/Downloads/R54NCD.pdf. Accessed May 29, 2008.
  13. Graling P , Elariny H . Perioperative care of the patient with morbid obesity . AORN J . 2003;77(4):802–824
  14. Maggard MA , Shugarman LR , Suttorp M , et al.   Meta-analysis: surgical treatment of obesity . Ann Int Med . 2005;142(7):547–559
  15. Commonwealth of Massachusetts Board of Registration of Medicine. Medical Board Patient Care Assessment Committee. Postoperative management of weight loss surgery patients. Boston, MA: January 2005.
  16. Commonwealth of Massachusetts Betsy Lehman Center for Patient Safety and Medical Error Reduction Expert Panel on Weight Loss Surgery: executive report . Obes Res . 2005;13(2):205–305
  17. Medical care for obese patients. Weight-Control Information Network. US Department of Health and Human Services. http://win.niddk.nih.gov/publications/medical.htm. Accessed May 20, 2008.
  18. Understanding adult obesity. Weight-Control Information Network. US Department of Health and Human Services. http://win.niddk.nih.gov/publications/understanding.htm. Accessed May 20, 2008.
  19. AORN bariatric surgery guideline . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 67–85
  20. Kremen AJ , Linner JH , Nelson CH . An experimental evaluation of the nutritional importance of proximal and distal small intestine . Ann Surg . 1954;140(3):439–448
  21. Griffen WO , Bivins BA , Bell RM . The decline and fall of jejunoileal bypass . Surg Gynecol Obstet . 1983;157(4):301–308
  22. Mason EE , Ito C . Gastric bypass in obesity . Surg Clin North Am . 1967;47(6):1345–1351
  23. Scopinaro N , Gianetta E , Adami GF , et al.   Biliopancreatic diversion for obesity at eighteen years . Surgery . 1996;119(3):261–268
  24. Mason EE . Vertical banded gastroplasty for obesity . Arch Surg . 1982;117(5):701–706
  25. Eckhout GV , Willbanks OL , Moore JT . Vertical ring gastroplasty for morbid obesity. Five year experience with 1,463 patients . Am J Surg . 1986;152(6):713–716
  26. Hess DS , Hess DW . Biliopancreatic diversion with a duodenal switch . Obes Surg . 1998;8(3):267–282
  27. Oria HE . Gastric banding for morbid obesity . Eur J Gastroenterol Hepatol . 1999;11(2):105–114
  28. Kuzmak LI , Yap IS , McGuire L , et al.   Surgery for morbid obesity. Using an inflatable gastric band . AORN J . 1990;51(5):1307–1324
  29. O'Brien PE , Dixon JB , Brown W , et al.   The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life . Obes Surg . 2002;12(5):652–660
  30. Dixon JB , O'Brien PE . Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding . Diabetes Care . 2002;25(2):358–363
  31. Johnston D , Dachtler J , Sue-Ling HM , King RF , Martin G . The Magenstrasse and Mill operation for morbid obesity . Obes Surg . 2003;13(1):10–16
  32. Cottam D , Qureshi FG , Mattar SG , et al.   Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity . Surg Endosc . 2006;20(6):859–863
  33. Shikora SA . Implantable gastric stimulation for the treatment of severe obesity . Obes Surg . 2004;14(4):545–548
  34. De Luca M , Segato G , Busetto L , et al.   Progress in implantable gastric stimulation: summary of results of the European multi-center study . Obes Surg . 2004;14(Suppl 1):S33–S39
  35. Gastrointestinal surgery for severe obesity. Weight-Control Information Network. US Department of Health and Human Services. http://win.niddk.nih.gov/publications/gastric.htm. Accessed May 20, 2008.
  36. Flum DR , Salem L , Elrod JB , Dellinger EP , Cheadle A , Chan L . Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures . JAMA . 2005;294(15):1903–1908
  37. Sugerman HJ . Editorial comment on recent reports in the Journal of the American Medical Association . Surg Obes Relat Dis . 2006;2(1):1–2
  38. Pratt GM , McLees B , Pories WJ . The ASBS Bariatric Surgery Centers of Excellence Program: a blueprint for quality improvement . Surg Obes Relat Dis . 2006;2(5):497–503
  39. ACS Division of Research and Optimal Patient Care. American College of Surgeons Bariatric Surgery Center Network (BSCN) Accreditation Program Manual. http://www.facs.org/cqi/bscn/program_manual.pdf. Accessed May 6, 2008.
  40. Ferraro DR . Laparoscopic adjustable gastric banding for morbid obesity . AORN J . 2003;77(5):923–944
  41. Hagedorn JC , Encarnacion B , Brat GA , Morton JM . Does gastric bypass alter alcohol metabolism? . Surg Obes Relat Dis . 2007;3(5):543–548
  42. Klockhoff H , Näslund I , Jones AW . Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery . Br J Clin Pharmacol . 2002;54(6):587–591
  43. Kleiner KD , Gold MS , Frost-Pineda K , Lenz-Brunsman B , Perri MG , Jacobs WS . Body mass index and alcohol use . J Addict Dis . 2004;23(3):105–118
  44. Silecchia G , Bacci V , Bacci S , et al.   Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up . Surg Obes Relat Dis . 2008;4(3):430–436
  45. National Institutes of Health  . Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults; the evidence report . Obes Res . 1998;6(Suppl 2):51S–209S
  46. Murray D . Morbid obesity-psychosocial aspects and surgical intervention . AORN J . 2003;78(6):990–995
  47. Jamal MK , DeMaria EJ , Johnson JM , et al.   Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity . Surg Obes Relat Dis . 2006;2(2):122–127
  48. Colles SL , Dixon JB , Marks P , Strauss BJ , O'Brien PE . Preoperative weight loss with a very-low energy diet: quantitation of changes in liver and abdominal fat by serial imaging . Am J Clin Nutr . 2006;84(2):304–311
  49. Myles PS , Iacono GA , Hunt JO , et al.   Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers . Anesthesiology . 2002;97(4):842–847
  50. Woehlck HJ , Connolly LA , Cinquegrani MP , Dunning MB , Hoffmann RG . Acute smoking increases ST segment depression in humans during general anesthesia . Anesth Analg . 2001;89(4):856–860
  51. Edwards JE . Pregnancy after bariatric surgery . Adv Nurses . 2007;9(9):25–27
  52. Olson AL , Zwillich C . The obesity hypoventilation syndrome . Am J Med . 2005;118(9):948–956
  53. Alpert MA . Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome . Am J Med Sci . 2001;321(4):225–236
  54. Pieracci FM , Barie PS , Pomp A . Critical care of the bariatric patient . Crit Care Med . 2006;34(6):1796–1804
  55. Hample H , Abraham NS , El-Serag HB . Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications . Ann Intern Med . 2005;143(3):199–211
  56. Knight KA. Understanding the surgical needs of morbidly obese patients. Nursing Spectrum Onlinehttp://include.nurse.com/apps/pbcs.dll/article?AID=2004405170342. Accessed May 29, 2008.
  57. McGlinich BP , Que FG , Nelson JL , Worbleski DM , Grant JE , Collazo-Clavell ML . Perioperative care of patients undergoing bariatric surgery . Mayo Clin Proc . 2006;81(10 Suppl):S25–S33
  58. Egorova NN , Moskowitz A , Glijns A . Managing the prevention of retained surgical instruments. What is the value of counting . Ann Surg . 2008;247(1):13–18
  59. Gawande AA , Studdert DM , Orav EJ , Brennan TA , Zinner MJ . Risk factors for retained instruments and sponges after surgery . N Engl J Med . 2003;348(3):229–235
  60. Hager C . Quality of life after Roux-en-Y gastric bypass surgery . AORN J . 2007;85(4):768–778

  indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article and taking the examination on pages 55–56 and then completing the answer sheet and learner evaluation on pages 57–58.You also may access this article online at http://www.aornjournal.org.The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as potential conflicts of interest in publishing this article.This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.

PII: S0001-2092(08)00121-X

doi: 10.1016/j.aorn.2008.02.015

AORN Journal
Volume 88, Issue 1 , Pages 30-58 , July 2008

Article Tools

* Image Usage & Resolution