Deviation in the Standard of Surgical Care During Bariatric Surgery (Weight Loss, Gastric Band, Sleeve, Diversion, Bypass)

Evaluate breaches in the standard of care by analyzing your fact pattern while answering the questions herein to determine whether or not there has or has not been a Deviation in the Standard of Surgical Care During Bariatric Surgery (Weight Loss, Gastric Band, Sleeve, Diversion, Bypass)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a comprehensive medical history obtained?
    Yes
    No
    Answer unknown
    Why is this important?
    It is imperative that a complete and thorough medical history be obtained prior to the consideration of bariatric surgery.
    (2010) 21 ECANCC 1 31

  • Was bariatric surgery medically indicated for the patient? Why is this important?
    Answer this question
    
Bariatric surgery is indicated in morbidly obese patients with co-morbidities to afford sustained weight loss.

    (2010) 21 ECANCC 1 31 



  • From which of the following co-morbidities did the patient suffer? Why is this important?
    Answer this question
    
In addition to obesity, many of these patients suffer from multiple other medical conditions.

    (2010) 21 ECANCC 1 31 



  • Did the clinician and the medical facility meet the criteria for bariatric surgery? Why is this important?
    Answer this question
    
The American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) have both developed programs to guide the provision of high quality care for bariatric surgery patients.

    (2012) 8 SURORD 2 e9 



  • Were the contra-indications of bariatric surgery addressed? Why is this important?
    Answer this question
    
Patients with severe liver disease, untreated major depression, alcohol/drug abuse, high anesthetic risks and those who are not in a condition to comply with the post-operative assessments are contra-indicated for bariatric surgery.

    (2010) 21 ECANCC 1 31-38 



  • Were the risks associated with bariatric surgery discussed? Why is this important?
    Answer this question
    
An increased risk of complications after bariatric surgery is seen in patients with a higher body mass index, in older patients, and in patients suffering from severe co-morbidities.

    (2012) 8 SURORD 1 1 



  • Did the patient undergo a pre-admission evaluation? Why is this important?
    Answer this question
    
Pre-operative assessment is necessary to optimize the outcome.

    (2006) 1 EPERNC 1 47 



  • Did the clinician address all the conditions of the surgery? Why is this important?
    Answer this question
    
Contra-indications that may exclude a person from having weight loss surgery include; any unstable medical condition, end-stage renal disease, or an active eating disorder.

    (2006) 1 EPERNC 1 47 



  • Did the clinician obtain an informed consent from the patient? Why is this important?
    Answer this question
    
Bariatric surgery can be performed only after the patient and the family have been; (1) counseled pre-operatively, (2) advised of all the risks associated with the surgery, and (3) advised of all of the conditions surrounding the surgery as well as the intense follow up regime that must be followed after the surgery.

    (2009) 18 ESPEDS 3 186 



  • Were the peri-operative complications of the surgery discussed? Why is this important?
    Answer this question
    
Knowledge of the various complications is necessary so that the patient will have a full understanding of the entire procedure.

    (2011) 21 EGECNA 2 241 



  • Which of the following bariatric surgical procedures did the patient undergo? Why is this important?
    Answer this question
    
The various bariatric procedures have unique risks and complications associated with them.

    (2011) 21 EGECNA 2 241 



  • Which of the following untoward outcomes did the patient experience? Why is this important?
    Answer this question
    
Bleeding, hematoma, cardiovascular complications, gastro intestinal complications, wound complications, and accidental puncture or laceration during a procedure all necessitate immediate medical management.

    (2010) 26 ECRICC 4 695 



  • Did the clinician advise post-surgical follow-up? Why is this important?
    Answer this question
    
Long-term medical follow-up is very important in achieving maximal weight loss after bariatric surgery.

    (2010) 110 JNLADA 4 600 



  • Was specialized post-operative care provided as needed? Why is this important?
    Answer this question
    
Patients with suspected obstructive sleep apnea must be admitted to a specialized surgical ward and monitored for respiratory insufficiency.

    (2010) 21 ECANCC 1 24 



  • Was the patient treated prophylactically with blood thinners? Why is this important?
    Answer this question
    
Venous thrombo-embolism is a leading cause of morbidity and mortality after laparoscopic gastric banding. Prophylaxis is beneficial to patients.

    (2009) 208 JNLACS 5 917 



  • Which of the following post-surgical complications did the patient experience? Why is this important?
    Answer this question
    
Bariatric surgery is riddled with many major complications. It is essential that the surgeon recognize the early signs of complications and manage them immediately.

    (2008) 34 EJNEMM 1 13-20 



  • Were the post-surgical complications managed appropriately? Why is this important?
    Answer this question
    
Due to the critical nature of the surgery and the co-morbidities of many of the patients, surgical complications require immediate intervention.

    (2008) 34 EJNEMM 1 13 



  • Was the patient advised periodic follow-up visits? Why is this important?
    Answer this question
    
Follow-up for bariatric patients is crucial.

    (2008) 34 EJNEMM 1 13