Best Practices in Bariatric Surgical Care – 2009 Update

Five years ago, while still in Hamilton, I paired up with Dr. Mehran Anvari (surgeon) to organise the first McMaster Bariatric Conference. Yesterday, I attended the 5th of these conferences.

Since our first meeting in 2004, the environment has certainly changed. With the recent announcement of Bariatric Centres of Excellence in Ontario, St. Joseph’s hospital in Hamilton has begun ramping up its bariatric program and I was most happy to see a good turn out of other bariatric surgeons, physicians and allied health staff at this conference.

While this was a pleasant opportunity to reconnect with a lot of good friends, the challenges of starting a bariatric program from scratch also became evident – given the new money available for expanding bariatric care (at least in Ontario), managing growth will be a major challenge. That said, my humble advise to all is to follow the evidence-based guidelines as closely as possible.

It may therefore be of interest for readers to note that last month’s issue of OBESITY dedicated 100 page to the 2009 update of the Betsy Lehman Center for Patient Safety and Medical Error Reduction (Boston, MA, USA) report on best practices in bariatric surgical care.

This report, based on the systematic review of over 1000 publications, makes recommendations on all aspects of bariatric care including:
– surgery
– multidisciplinary care
– behavioural and psychological assessment and management
– informed consent and patient education
– anesthetic and perioperative management
– nursing care
– facilities and resources
– policy and access
– data collection
– pediatric and adolescent surgery
– endoscopic procedures

The paucity of evidence in the field is evident from the fact that the vast majority of recommendation are based on Grade C and D evidence. Nevertheless, this is the best evidence we can currently base our approaches and treatments on – clearly lots of room for research.

AMS
Hamilton, Ontario