Evaluation of the obese patient requires identification of all comorbidities and health conditions, including underlying cardiac and pulmonary conditions that could have a negative outcome on noncardiac surgery. Once comorbidities have been recognized, aggressive optimization of these medical conditions can provide improved outcomes after bariatric surgery. Estimating medical risk can be performed by several validated classification systems. The preoperative checklist and clinical practice guidelines (CPG) were updated in 2013. The CPG recommendations for preoperative evaluation of the bariatric surgery patient include lab testing, nutritional screening, endocrine assessment, and cardiopulmonary assessment, including sleep apnea screening. The CPG suggest an extensive multidisciplinary team approach to the preoperative bariatric surgery patient. Finally, the medical evaluation includes an algorithm for a seven-step approach to the preoperative visit. Also recommended for evaluation of the morbidly obese patient is an algorithm that uses a five-step approach after a comprehensive history and physical exam and lab testing.
‘ Negativicoccus massiliensis ’, a new species identified from human stool from an obese patient after bariatric surgery
