Care of the Bariatric Surgery Patient in the Emergency Department

Samuel D. Luber, MD, MPH; David R. Fischer, MD; Arvind Venkat, MD

Disclosures

J Emerg Med. 2008;34(1):13-20. 

In This Article

Abstract and Introduction

Abstract

Obesity has reached epidemic proportions in the United States, with an estimated 50% of adults meeting the definition of being overweight. As this condition has become more prevalent, bariatric surgery has become an increasingly accepted form of treatment of the severely obese. Patients who have had bariatric surgery are presenting more commonly to Emergency Departments as a result. This article will review the most common bariatric surgery procedures, the complications that can arise post-operatively, and the approach to the assessment and management of the bariatric surgery patient in the Emergency Department.

Introduction

Obesity has become one of the most prevalent conditions in the United States. More than 50% of adults meet the clinical definition of being overweight or obese, and 5% are considered severely obese.[1] Obese individuals are at elevated risk for a number of conditions that can increase mortality, including Type II diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, asthma, cardiovascular disease, gallbladder disease, and obstetric complications.[2,3] As a result, obesity is one of the most common causes of preventable mortality in the United States.[4] Unfortunately, medical treatment and dietary and lifestyle changes have proven to be of minimal benefit to those who are morbidly obese.[1,5] However, surgical treatment of obesity provides morbidly obese individuals with sustained weight loss and significant reductions in the diseases associated with excess weight.[6]

There has been a dynamic growth in the number of bariatric surgical procedures for obesity. From 1990 to 2000, the national annual rate of bariatric surgery increased nearly six-fold, from 2.4 to 14.1 per 100,000 adults.[7] Recently, less invasive techniques, specifically laparoscopic bariatric surgery, have become commonplace in the treatment of morbid obesity. This review will discuss the most common surgical procedures for the treatment of obesity, the complications that can arise post-operatively, and the assessment and management of the bariatric surgery patient who presents to the Emergency Department (ED).

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