Bariatric Surgery: Post-Operative Management
Key messages for healthcare professionals
- Supporting patients with consistent use of postoperative behavioural plans (including managing nutrition and activity, thoughts and emotions, post-op vitamins and medications and skincare) can optimise obesity management and health while minimising post-operative complications.
- Working in partnership, healthcare professionals (HCPs) working at all levels of the Model of Care for Management of Obesity in Ireland need to support the patient living with obesity to establish and commit to a shared care model of chronic-disease management for long-term follow-up1.
- The primary care HCP should refer patients with postbariatric surgery complications, that cannot be managed at Levels 1-3 of the Model of Care, back to Level 4 for specialist hospital care.
Recommendations
- Healthcare professionals (HCPs) can encourage people who have undergone bariatric surgery to participate and maximise their access to behavioural interventions and health and social care services at a Level 4 bariatric surgical centre (Level 2a, Grade B)2,3 or the appropriate service for the level of care required (Level 4, Grade D, consensus). We suggest post-operative follow-up care is delivered at a Level 4 bariatric surgical centre for a minimum of two years (Level 4, Grade D, consensus).
- We suggest that Level 4 bariatric surgical centres communicate a comprehensive care plan to the primary care HCP and other services as relevant on patients who are discharged, including bariatric procedure, emergency contact numbers, annual blood tests required, long-term vitamin and mineral supplements, medications, behavioural interventions and when to refer back (Level 4, Grade D, consensus).
- We suggest that after a patient has been discharged from the Level 4 bariatric surgical centre, care provided at Levels 1-3 of the Model of Care should annually review nutritional intake, activity, compliance with multi-vitamin and mineral supplements and weight, as well as assess comorbidities, order laboratory tests to assess for nutritional deficiencies and investigate abnormal results and treat as required (Level 4, Grade D, consensus).
- We suggest that primary care HCPs consider referral back to the Level 4 bariatric surgical centre or Level 3 specialist services for technical or gastrointestinal symptoms, nutritional issues, pregnancy, psychological support, weight regain or other medical issues as described in this chapter related to bariatric surgery (Level 4, Grade D, consensus).
- We suggest that Level 4 bariatric surgical centres provide follow-up and appropriate laboratory tests at regular intervals post-surgery with access to appropriate HCPs (as per the Model of Care) until discharge is deemed appropriate for the patient (Level 4, Grade D, consensus).
Key messages for people living with obesity who have had bariatric surgery
- If you have had bariatric surgery, it is essential for you to take your nutritional supplements lifelong and continue to follow the post-bariatric surgical nutrition and physical activity plans and any other recommendations agreed with your bariatric team. By doing this, you will increase your chances of staying healthy and reduce complications that can arise from bariatric surgery.
- Attend all scheduled appointments and programmes offered by your bariatric surgical service. Once you are discharged from the bariatric surgical site, schedule annual appointments with your primary care healthcare professional (HCP); this may be your general practitioner and/or your local Level 2/3 Obesity service to check your bloodwork, reassess your medications and address any health issues related to changes in your weight.
- After bariatric surgery, it is possible that there can be a negative impact on mood, relationships, body image, development of addictions and reduced ability to cope with stress. If you are struggling, discuss this with your original specialist team or, if you have been discharged, with your primary care HCP.
- Remember that your lowest weight post-surgery will typically occur between 12 and 18 months. After this, there is a natural increase in weight that occurs. If you are re-gaining and concerned that this is affecting your health, discuss this with your bariatric team or primary care HCP.
- Appropriate contraception should be used until rapid weight loss has stopped and/or weight stability has occurred. If you are 12 to 18 months post-bariatric surgery and are planning a pregnancy, discuss this with your bariatric team, primary care HCP and obstetrician.
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