could be an outpatient option.
He does, however, offer some important
caveats. As a bariatric surgeon, even though
you're using micro-instruments to make smaller
incisions, controlling the patient's nausea and
post-operative pain — without opioids, if at all
possible — is essential. Also, you must have
access to an IV infusion center nearby to prevent
patients from getting behind on their fluids,
which may contribute to kidney failure and other
post-operative complications. His best piece of
advice: Select patients carefully.
"If you have good patient selection, bariatric sur-
gery can be safer to do than a gallbladder removal,"
he says. "Someone with a lower BMI might be a
better candidate. Younger might be better. Female
might be better."
There's a fine line between patients who are bet-
ter for inpatient versus outpatient, he says. In gen-
eral, those with a BMI of 40 and lower would be
suitable for outpatient settings, while those who
have a BMI of more than 40 would best be treated
in a hospital. Also, obstructive sleep apnea would
be a contraindication for outpatient surgery.
Compared to some other procedures, the need
for pre- and post-operative education may be
greater for patients undergoing bariatric surgery
because of their struggles with food addiction. Dr.
Uchal meets with patients multiple times, but he
also prescribes structured bariatric education and
membership in a support group.
— Bill Donahue
M a y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 4 9
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