Focus on: Bariatric surgery, complications, litigation

© The Medical-Legal News, 2007

The number of obese patients who are choosing bariatric surgery is increasing, as is the number of surgeons who perform the procedure and the number of hospitals that provide the specialized care required for this patient population [see graphic, Page 3].
When surgery is performed appropriately and the patient does not suffer postoperative complications, it can be a life-saving procedure, leading to a decreased need for medication and healthcare-associated costs for chronic diseases such as diabetes, hypertension, heart disease, sleep apnea and orthopedic arthritic conditions that plague the morbidly obese population.
When complications occur, the pendulum swings to life-threatening, affecting all major body systems to include septic shock, adult respiratory distress syndrome, fluid volume imbalances, renal failure from rhabdomyolysis, thrombotic complications or serious nutritional deficits.
With such a high-risk surgery in a high-risk patient population, allegations of medical and nursing malpractice will occur and have been on the rise with the increase in surgeons and facilities that offer these procedures. These allegations may include inadequate informed consent, failure to optimize medical management of pre-existing chronic disease, surgical errors, early postoperative complications and late postoperative complications.
The links and references are provided to familiarize the attorney, legal nurse consultant and expert witness with various professional organizations, guidelines and publications that may assist in evaluating a case involving bariatric surgical patients.

Web sites

• AORN Bariatric Surgery Guideline:
http://findarticles.com/p/articles/mi_m0FSL/is_5_79/ai_n6074287

— Association of Perioperative Registered Nurses publication for establishing bariatric services and providing perioperative care to the bariatric patient.

• Postoperative Nursing Care of the Bariatric Patient:
http://www.perspectivesinnursing.org/pdfs/Perspectives24.pdf

• National Guideline Clearinghouse, Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Guidelines for the clinical application of laparoscopic bariatric surgery: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4383&string=obesity

• American Society for Bariatric Surgery: http://www.asbs.org

• ASBS Guidelines and Statements: 
http://www.asbs.org/Newsite07/resources/asbs_guidelines.htm

• American Society of Bariatric Physicians http://www.asbp.org

• American College of Surgeons Recommendations for Facilities Performing Bariatric Surgery:
http://www.facs.org/fellows_info/statements/st-34.html

• SAGES Publication: Guidelines for Laparoscopic Bariatric Surgery http://www.sages.org/sagespublication.php?doc=30

• National Institutes of Health Consensus Development Programs: Gastrointestinal Surgery for Severe Obesity: 

http://consensus.nih.gov/1991/1991GISurgeryObesity084html.htm

• National Institutes of Health Clinical Executive Summary - Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: 
http://www.nhlbi.nih.gov/guidelines/obesity/ob_exsum.pdf

• Guidelines for the Clinical Application of Laparoscopic Bariatric Surgery:
http://www.guideline.gov/summary/summary.aspx?doc_id=4383&nbr=003301&string=term

• NAASO The Obesity Society - Obesity Online Slides
http://www.obesityonline.org/slides/slide01.cfm?q=guidelines

• Complications of Bariatric Surgery 
http://www.danaise.com/bariatric.htm 

Books

• “Management of Morbid Obesity” by Harvey J. Sugerman, Ninh Nguyen (Editors); Informa Healthcare, 2005

• “Morbid Obesity: Peri-Operative Management” by Adrian O. Alvarez, Jay B. Brodsky, Martin A. Alpert, George S. M. Cowan (editors); Greenwich Medical Media, 2004

• “Surgical Management of Obesity” by Henry Buchwald, George S. M. Cowan, Walter J. Pories (Authors); Saunders, 2006

• “Laparoscopic Bariatric Surgery” by William B. Inabnet, Eric J. DeMaria, Sayeed Ikramuddin (authors); Lippincott Williams & Wilkins, 2004

• “Minimally Invasive Bariatric Surgery” by Phillip R. Schauer, Bruce D. Schirmer, Stacy Brethauer (editors); Springer, 2007

• “Bariatric Surgery, An Issue of Perioperative Nursing Clinics (The Clinics: Nursing)” by Brenda S. Dawes (Author); Saunders, 2006. •

Pam Hollsten, RN, BSN, LNCC is a legal nurse consultant with over ten years experience in medical malpractice and catastrophic personal injury cases.

roux-en-Y gastric bypass graphic.