Preparation for Surgery

What are the routine tests before surgery?

Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), a comprehensive Chemistry Panel, which gives a readout of about 20 blood chemistry values, a Cholesterol Panel, Thyroid Function Test, Iron levels, B12 levels, and an arterial blood gas. All patients get a chest X-ray and an electrocardiogram. Most patients will also get a psychiatric examination. Due to the high incidence of obstructive sleep apnea, most patients will require a sleep lab study. Patients with symptoms consistent with gallbladder disease may get an abdominal ultrasound. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation or cardiology evaluation will be requested when indicated.

What is the purpose of all these tests?

An accurate assessment of your health is needed before surgery. The best way to avoid complications is to decrease their risk of occurring. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels. Our objective is to maximize your likelihood of success.

Why do I have to have a Sleep Study?

The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate and can be present in nearly 70% of obese patients. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time and can lead to a higher complication rate. It is important to have a clear picture of what to expect and how to handle it.

Why do I have to have a Psychiatric Evaluation?

Weight loss surgery will require significant changes in your lifestyle and will also change your life. A psychiatric evaluation will help prepare you for these changes by developing coping skills and encouraging behavior modification. Additionally, our psychiatrists and psychologists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?

Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade a surgeon recommending weight loss surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average. It is important that the patient and his or her family members understand these risks.

What can I do before the appointment to speed up the process of getting ready for surgery?

  • Select a primary care physician if you don't already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA). Also, for those over fifty, a colonoscopy should be scheduled.
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon - this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.