TABLE 6.
Postoperative Checklist for Bariatric Surgery*
| Checklist Item | LAGB | LSG | RYGB | BPDDS | |
|---|---|---|---|---|---|
| Early postoperative care | |||||
| ✓ | monitored telemetry at least 24 hr if high risk for MI | ✓ | ✓ | ✓ | ✓ |
| ✓ | protocol-derived staged meal progression supervised by RD | ✓ | ✓ | ✓ | ✓ |
| ✓ | healthy eating education by RD | ✓ | ✓ | ✓ | ✓ |
| ✓ | multivitamin plus minerals (# tablets for minimal requirement) | 1 | 2 | 2 | 2 |
| ✓ | calcium citrate, 1200–1500 mg/d | ✓ | ✓ | ✓ | |
| ✓ | vitamin D, at least 3000 units/d, titrate to >30 ng/mL | ✓ | ✓ | ✓ | ✓ |
| ✓ | vitamin B12 as needed for normal range levels | ✓ | ✓ | ✓ | ✓ |
| ✓ | maintain adequate hydration (usually >1.5 L/d PO) | ✓ | ✓ | ✓ | ✓ |
| ✓ | monitor blood glucose with diabetes or hypoglycemic symptoms | ✓ | ✓ | ✓ | ✓ |
| ✓ | pulmonary toilet, spirometry, DVT prophylaxis | ✓ | ✓ | ✓ | ✓ |
| ✓ | if unstable, consider pulmonary embolus (PE), intestinal leak (IL) | PE | PE | PE/IL | PE/IL |
| ✓ | if rhabdomyolysis suspected, check CPK | ✓ | ✓ | ✓ | ✓ |
| Follow-up | |||||
| ✓ | visits: initial, interval until stable, once stable (months) | 1,1–2,12 | 1,3–6,12 | 1,3,6–12 | 1,3,6 |
| ✓ | monitor progress with weight loss and evidence of complications each visit | ✓ | ✓ | ✓ | ✓ |
| ✓ | SMA-21, CBC/plt with each visit (and iron at baseline and after as needed) | ✓ | ✓ | ✓ | ✓ |
| ✓ | avoid nonsteroidal antiinflammatory drugs | ✓ | ✓ | ✓ | ✓ |
| ✓ | adjust postoperative medications | ✓ | ✓ | ✓ | ✓ |
| ✓ | consider gout and gallstone prophylaxis in appropriate patients | ✓ | ✓ | ✓ | ✓ |
| ✓ | need for antihypertensive therapy with each visit | ✓ | ✓ | ✓ | ✓ |
| ✓ | lipid evaluation every 6–12 months based on risk and therapy | ✓ | ✓ | ✓ | ✓ |
| ✓ | monitor adherence with physical activity recommendations | ✓ | ✓ | ✓ | ✓ |
| ✓ | evaluate need for support groups | ✓ | ✓ | ✓ | ✓ |
| ✓ | bone density (DXA) at 2 years | ✓ | ✓ | ✓ | ✓ |
| ✓ | 24-hour urinary calcium excretion at 6 months and then annually | ✓ | ✓ | ✓ | ✓ |
| ✓ | B12 (annually; MMA and HCy optional; then q 3–6 months if supplemented) | ✓ | ✓ | ✓ | ✓ |
| ✓ | folic acid (RBC folic acid optional), iron studies, 25-vitamin D, iPTH | x | x | ✓ | ✓ |
| ✓ | vitamin A (initially and q 6–12 months thereafter) | x | x | optional | ✓ |
| ✓ | copper, zinc, and selenium evaluation with specific findings | x | x | ✓ | ✓ |
| ✓ | thiamine evaluation with specific findings | ✓ | ✓ | ✓ | ✓ |
| ✓ | consider eventual body contouring surgery | ✓ | ✓ | ✓ | ✓ |
*
see text for abbreviations; based on general obesity-related risks, GI functional anatomy, and clinical endpoints after specific bariatric surgical procedures.