A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/594234
39 Bariatric Center Spotlight Bariatric Times • November 2015 is sized for the bariatric patient. Every exam room has a table that can a ccommodate any patient of any size. Tables are low to the floor so patients do not have to climb to get onto them. Bathrooms are also equipped for the bariatric patient. We are fortunate to have a comprehensive bariatric retail store that stocks multiple vitamin and mineral lines as well as a full complement of protein supplements, meal replacement items, snacks and beverages. We also offer books, pedometers, scales and fitness tracking devices. All of the items in our store are competitively priced and really available as a convenience for our patients and the community at large. All of our surgeries are performed at Sentara Norfolk General Hospital. The operating room at Sentara Norfolk General Hospital is fully staffed according to ASMBS and ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MSBAQIP) Center of Excellence guidelines for patients up to 1,000 pounds. We go above and beyond the MBSAQIP requirement by offering a specialty pod for patients to recover. The bariatric patient pod has six beds specifically designed and outfitted for postsurgical patients. It also features bariatric seating and extra wide doors to accommodate the extra wide beds and stretchers. Every room in the center has an overhead lift for patients who need help getting in and out of bed. All nurses are specialty trained to care for bariatric patients. PROCEDURE STATISTICS AND PATIENT DEMOGRAPHICS Our team consistently performs over 350 surgical cases a year. As with most bariatric programs, 80 percent of our surgical patients are women. The average BMI is 48, and the average age is 47. Table 1 shows the percentage and types of surgical procedures performed to date. From 2008 to 2010, gastric bypass made up the majority of procedures (45–56%) f ollowed by LAGB (35–48%). In 2011, we began performing laparoscopic sleeve gastrectomy (LSG). Since then, the percentage of LSGs has steadily increased from 30 to 88 percent. Both bypass and LAGB procedures have drastically decreased as LSG gained in popularity at our center and throughout the world. We continue to have excellent outcomes. In the most recent 2014 Semiannual Report from the MBSAQIP all of our sleeve outcomes were as expected with four categories being exemplary. Since beginning our laparoscopic program 15 years ago we have a mortality rate of 0.1% which is below the national average. ACHIEVING ACCREDITATION DESIGNATION Our program was the second program in Virginia to receive the American College of Surgery designation as an Adult and Adolescent Bariatric Center of Excellence (COE). We have undergone two three-year reaccreditations, and are undergoing our site visit for the MBSAQIP program before the end of 2015. We have fully endorsed the COE process from the very beginning. The process reinforced and highlighted all the good things that we were doing, as well as areas for improvement. Dr. Wohlgemuth was actively involved in the ACS BSCN program as a reviewer and advisory board member, and now serves on the verification subcommittee of the advisory board. We explain MBSAQIP accreditation to our patients at our information sessions, which we offer online and in-person. We are also completely HIPAA compliant. PATIENT ENGAGEMENT AND ASSESSMENT Patient engagement begins at one of our six monthly public information sessions. From there, all interested patients are scheduled for their initial surgical consultation with one of our four bariatric surgeons. A standard history and physical is performed with special attention to appropriateness for entry into our bariatric surgical program. Our bariatric trained psychologist meets with the patient to assess whether there are any major psychological or behavioral issues that may impede success. If the patient has obesity related comorbidities, such as obstructive sleep apnea (OSA), cardiovascular disease, or type 2 diabetes mellitus (T2DM), we refer them to appropriate specialists. A bariatric anesthesiologist sees high- risk patients before undergoing any weight loss operation. All clinical members of the staff meet once a month to discuss difficult patient cases. We call this our "red flag" meeting. We have a number of patients who qualify for surgery according to the currently accepted NIH guidelines but don't have insurance coverage. These patients have the option of entering our self-pay program or entering into our comprehensive medical weight loss program run by our board certified medical bariatrician, Dr Beasley. Additionally, many patients considered too high risk due to excessive weight are referred to the medical side for aggressive weight loss prior to entry into the surgical program. PATIENT ADHERENCE AND FOLLOW UP We believe that our team members and patients should set realistic expectations for weight loss prior to surgery. We tell our patients that they are our patients for life, not just during the preoperative period. We encourage them to come back yearly after the two-year mark. We find that most patients do adhere to follow-up appointments during the first postoperative year; however, there is a decline in adherence after one to two years. Long-term follow-up continues to vex all COE programs and we are no Operating room at Sentara Norfolk General Hospital in Norfolk, Virginia Sentara Comprehensive Weight Loss Solutions' bariatric retail store stocks multiple vitamin and mineral lines as well as a full complement of protein supplements, meal replacement items, snacks, and beverages. We also offer books, pedometers, scales, and fitness tracking devices. TABLE 1. Case percentages of procedures performed by the Sentara Comprehensive Weight Loss Solutions team. YEAR BYPASS REVISIONS BANDS SLEEVE 2015 YTD 7 4 <1 88 2014 19 6 <1 74 2013 29 11 1 59 2012 39 13 3 45 2011 46 9 15 30 2 010 5 6 9 35 0 2009 45 7 48 0 2008 51 3 46 0