Coronavirus Chronicles — Bariatric Surgery

Currently, institutions must limit themselves to the most basic functions, and cast others by the wayside. For instance, Denver Health announced that its Bariatric Surgery Center had to cancel both its monthly seminar and support group for April, and to cease all nutrition and psychology clinic appointments until further notice.

The Centers for Disease Control and the Centers for Medicare and Medicaid Services announced in mid-March that elective surgeries should be delayed. Hospitals need the beds, as well as the masks and other personal protective equipment. In the area of equipment that should be reserved for coronavirus patients, ventilators are the obvious leading candidate. But hospitals use many different machines and devices, all of which have to be assigned to priority usage, moved around, kept track of, cleaned, maintained, calibrated, and operated by professionals who know what they are doing.

Equipment is of course not the only resource that needs to be protected. Many healthcare providers from various specialties are being drafted into service against the COVID-19 pandemic. In addition to doctors and nurses, hospitals need custodians, clerical staff, kitchen and cafeteria workers, security personnel, IT specialists, and many others.

Some have died, while others are sick or soon will be. Since the ability to test individuals for the illness is drastically limited, the possibility even exists that patients who are hospitalized for other reasons could catch it from medical personnel, which would be terribly and tragically ironic. Anyone who does not absolutely need hospital care during this period is much better off at home.

The T word

Triage is a frightening word. It means assigning urgency ratings to the needs of suffering people, and allocating the available resources accordingly. It demands that judgments be made; it creates losers and winners. To help figure out how to manage this process during the current crisis, the American College of Surgeons published its seven “overarching principles,” along with more detailed recommendations for a number of surgical specialties, including metabolic and bariatric surgery.

An emergency situation is one that needs immediate intervention because of imminent death or permanent organ damage. For bariatric patients, this would almost exclusively apply to post-operative patients who are affected by:

Perforated marginal ulcer, bleeding, anastomatic or staple-line leak, obstruction particularly internal hernia, gastric band perforation or prolapse…

The next most serious category includes patients whose surgeries can be put off for a few days or even weeks, and those conditions include:

[…] revisions for dysphagia, severe gerd, pain, dehydration/malnutrition, slipped band, anastomotic strictures at risk for aspiration…

At a time like this, elective surgeries (which includes first-time bariatric procedures) should not be performed, and even if a patient feels inclined to insist, it is unlikely that any institution would admit them.

The Obesity Action Coalition has issued a letter to “those who are currently engaging in insurer or employer-mandated weight management prior to bariatric surgery or other obesity care,” urging them to cooperate in certain ways. Insurance providers are asked to make sure their processes for approving and completing bariatric procedures stay fully operational. If you are an insurer, they request that:

You not deny patients for missing required monthly weight checks, as many people are being asked to limit travel, self-quarantine due to age, and delay non-essential medical visits.

You waive any requirement for weight-loss (or no weight gain) during said required medical weight management periods due to the limited food environment, lack of fitness facility availability, individual counseling sessions being cancelled, stress, etc.

All pre-authorizations be processed recognizing that some information may be limited due to current restrictions and patients not be penalized for missing such information.

If surgery is delayed by a facility having to limit care due to public need (capacity issues/limiting of non-emergency procedures, etc.) that those pre-authorizations be honored as soon as such capacity issues are addressed.

Your responses and feedback are welcome!

Source: “Bariatric Surgery Center,” DenverHealth.org, undated
Source: “Coronavirus: Follow 7 Overarching Principles for Delaying Elective Surgery,” HealthLeadersMedia.com, 03/27/20
Source: “COVID-19 Guidelines for Triage of Metabolic and Bariatric Surgery Patients,” FACS.org, 03/24/20
Source: “Insurance Provider Letter,” NetDNA-ssl.com, 03/19/20
Image by ScienceDirect.com

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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