Background

Best practice advises a multi-disciplinary approach for evaluation of bariatric surgery candidates to optimize suitability. Few studies have addressed team evaluation processes. Standardized guidelines are lacking. This study describes the characteristics and final outcomes of high risk candidates.

Methods

A retrospective record review was conducted on candidates identified as high risk and reviewed by the interdisciplinary team from August 2012 through December 2017. The high risk designation was based on results of pre-surgery psychological, dietetic, surgical, medical, social/behavioral assessments and staff observations. A descriptive data analysis resulted in risk indicator and outcome categories.

Results

A total of 531 patients (76.8% female) were identified, having one or more risk indicators (see Table). After prescribed interventions, outcomes included: surgery 136(25.6%), not a candidate 162(30.5%), left program-no contact 193(36.3%), and reported stopping the work-up 33(6.2%). Additionally 7 (1.3%) post-surgery patients were reviewed. Patients who proceeded to surgery had less psychological (6.8%) and more dietetic (6.1%) risk indicators than the total group. %TWL at 1 year (n=62) and 2 years (n=14) were 23±11.8 and 15.1±14, respectively, outcomes comparable to those seen in non-IDT sleeve gastrectomy patients at our center (see Figure).

Conclusions

The interdisciplinary approach of high risk candidate review supported safe surgery for 136 patients who might otherwise not been offered surgery. This process identified a subset as unstable to safely proceed to surgery. The ongoing identification of risk indicators, interventions, and monitoring outcomes informs process improvements for the program.