What You Need to Know About Preoperative Testing for Bariatric Surgery
May 22, 2017The decision to start the weight loss surgery process can be difficult. You may feel overwhelmed, excited, anxious, or unsure of what will come next. Be assured that your multidisciplinary team of surgeons, nurses, dietitians and psychologists will provide education on weight loss methods and help you decide which option is best for you. The start of your journey will include the preoperative testing for bariatric surgery.
After your initial consult, you will be required to complete several preoperative tests and appointments. The purpose of preoperative screening is to make sure that you are safe in the operating room and successful long-term. Each test will be explained in detail by your medical provider.
It’s important to understand that your individual preoperative screening requirements may be different than someone else who is having bariatric surgery. The types of preoperative tests are determined by your past medical and surgical histories and your particular insurance requirements.
The Process of Preoperative Testing for Bariatric Surgery
BARIUM SWALLOW: Your provider may order an imaging study called a barium swallow. This test is completed in the Radiology Department. You will be required to drink a contrast. During the swallow study, images will be taken to visualize and analyze a rapid sequence of events that occur when swallowing. This test can detect the severity of acid reflux and any abnormalities in the upper gastrointestinal tract. It basically gives your surgeon a “road map” of your anatomy. Sometimes the result of this test can determine which bariatric surgery procedure would be best for you.
EKG: Your provider may order cardiac imaging studies (EKG, cardiac echo and stress test). During an EKG, small electrode patches are placed on your chest to detect the electrical activity of your heart. A cardiac echo is an ultrasound, and it evaluates the structure and function of the valves and chambers of your heart. There are two different types of stress tests, an exercise, and pharmacologic stress test.
EXERCISE STRESS TEST: During an exercise stress test, you will walk on a treadmill or use an exercise bike. Your cardiac function will be evaluated using an EKG and blood pressure machine.
PHARMACOLOGIC STRESS TEST: If you are unable to exercise you will do a pharmacologic stress test. For this test, you are given a medication to increase blood flow to your heart to mimic the changes that occur to your heart while exercising.
Cardiac tests are typically ordered on patients who have a history of cardiac disease, an unstable cardiac condition, heart failure, stroke, history of uncontrolled diabetes over five years, renal insufficiency, significant arrhythmias, heart valve issues, swelling of extremities, or if you are over 50 years of age.
ULTRASOUND: Your provider may order an ultrasound of your gallbladder. This test is ordered if you are having right upper quadrant abdominal pain, especially when eating a meal high in fat. The ultrasound will be able to detect gallbladder inflammation or gallstones. If abnormalities are found, your gallbladder may be removed at the same time as your bariatric surgery. This test is fast and non-invasive.
LABS: Labs are routinely ordered at an initial consult. Labs tests include a complete blood count (CBC), Comprehensive Metabolic Panel (CMP), lipid panel, iron studies, thyroid function tests, hemoglobin A1c, h.pylori, and Vitamins A, E, D, B1, B12. Your providers will address any abnormalities, and treat any vitamin deficiencies accordingly.
SMOKING CESSATION: Smoking cessation is considered an important part of the pre-operative screening process. You will be required to quit smoking at least two months prior to surgery, and forever after surgery.Smoking slows the healing process by decreasing blood flow to the protective lining of the stomach and other vital organs and decreases the secretion of mucus that protects the stomach. As a result, you can develop significant postoperative complications such as a life-threatening bleeding ulcer that can perforate; slowed wound healing and increased risk for infections; increased risk a blood clot, and respiratory complications. You will be encouraged to collaborate with your primary care doctor to discuss smoking cessation strategies.
WEIGHT LOSS GOAL: You may be required to lose at least 5% of your current body weight before going into the operating room. Getting into healthy habits with diet and exercise before surgery will set up you up for long-term success after surgery. Find an exercise regimen that works for you. Start small. Don’t over-do it too soon and injure yourself if you don’t already have an exercise routine. Start slow, and begin to increase the intensity, distance, and length of time of your exercise routine – eventually doing cardio exercise at least 45 minutes, five days a week.
You can join a gym, YMCA, exercise at home with workout DVD’s, or exercise outside. Also, many shopping malls open early so that you can walk loops around the mall – a great option in the winter. Many people will ask if walking your dog is considered cardio exercise. It is not. You need to get your heart rate up for a sustained period of time. Get a sweat going, feel your heart rate and breathing rate go up and really make your exercise a part of your daily routine. Certainly, if you have any cardiac or mobility limitations, speak with your primary care doctor.
Losing 5% or more of your weight will also help shrink your liver. If you are overweight or obese, you likely have fatty liver disease – which means your liver is larger in size compared to somebody who doesn’t have fatty liver disease. The surgeon needs to lift up your liver in the operating room to access your stomach to perform the surgery. Losing weight before surgery decreases your risk for organ injury and postoperative complications. Exercise, diet and behavioral changes, will help you meet your weight loss goal.
SLEEP MEDICINE: Obstructive sleep apnea (OSA) is a very common obesity-related condition. If it is indicated that you are high risk for sleep apnea, you will be referred to a pulmonologist to have an overnight sleep study. You may have OSA if you often feel tired during the day, if you snore loudly when sleeping, if anyone has observed you stop breathing during sleep, you have or are being treated for high blood pressure, have a BMI >35, are over 50 years old, male, and have a neck circumference >16 inches.The sleep study will evaluate how many times you stop breathing at night and how low your oxygen saturation gets in your blood. If it is indicated that you have OSA, you will be required to use a CPAP machine during sleep. The machine helps you breathe better at night, and will improve your sleep. Most hospitals require that you bring your machine to the hospital the day of surgery.
NUTRITION: You will be required to meet with a dietitian many times before surgery. The dietitian will assess your diet, provide information about healthy eating and how to make appropriate food choices. They will ask what you eat throughout the day, who prepares your meals for you, who purchases your food, where you shop in the grocery store and emotional food triggers. In order to get the most out of these visits, don’t be afraid to be honest and share your weaknesses or if you ate something you shouldn’t have. The dietitians want to help you get healthy and make sure you are successful.
MENTAL HEALTH PROFESSIONAL: You will be required to meet with a therapist, psychiatrist or licensed social worker before surgery. You may meet with them once, or many times, depending on your needs and the providers’ evaluation. Most weight loss clinics have mental health providers on-site. If you have your own mental health provider that you see on a regular basis, you may able be able to see them for psychiatric clearance. The purpose of this evaluation is to make sure that you have a good support system, have adequate coping mechanisms in place, are able to control emotional eating triggers and that you understand your responsibilities in the surgical process to make sure that you are successful.
If a test is abnormal, you may need to complete additional testing or be required to follow-up with a specialist. The surgeon will address the results of each test to determine if the result would affect your safety in the operating room and success long-term.
Timeframe to Complete the Preoperative Tests
The preoperative tests are completed at your convenience and are often booked by the administrative staff at your clinic. All testing is good for one year, unless that there are significant changes in your medical history. Most patients complete preoperative testing within 4-6 months from your initial consult.
Once all testing is complete, the results of all of your testing will be sent to your insurance company for approval. Depending on your particular insurance plan, the insurance approval process can take anywhere from one to six weeks. During this time, it’s important that you continue exercising and eating healthy. Once the surgery is approved by your insurance company you will get a call from the clinic to give you a surgery date.
Should you have any questions about the preoperative screening process, or why a particular test is being ordered, don’t hesitate to ask. The providers are there to help you and answer any questions you have along the way. Know that this process is not designed to inconvenience you in any way, in fact, most clinics try to schedule all of your appointments and imaging studies on the same day if possible. And remember, the purpose of this testing is to make sure that you are safe and successful long-term.
 | ABOUT THE AUTHOR Megan Goulard is a board-certified family nurse practitioner at St. Elizabeth's Medical Center. She completed her baccalaureate degree in health sciences and master's degree in family practice nursing at Regis College in Weston, Massachusetts. Goulard developed a keen passion and interest in working with weight loss surgery patients during an internship at Brigham and Women's Hospital. She is dedicated to helping her patients achieve long-term success and is committed to providing individualized patient care. |
