Pre-Operative Care | PCP Toolkit

Patient Selection and Referral Criteria

Primary care physicians play a central role in identifying patients who may benefit from bariatric surgery. Current clinical guidelines recommend considering surgical referral for patients who meet the following criteria:

Body Mass Index (BMI) of 40 or greater without obesity-related comorbidities
BMI of 35 or greater with at least one significant obesity-related comorbidity such as type 2 diabetes, hypertension, obstructive sleep apnea, or non-alcoholic fatty liver disease
BMI of 30 or greater with poorly controlled type 2 diabetes or metabolic syndrome (on a case-by-case basis)
Documented history of unsuccessful sustained weight loss through non-surgical approaches

Required Pre-Surgical Assessments

Before a patient proceeds to surgery, the following evaluations should be completed or coordinated through the primary care office:

Medical Evaluation

Comprehensive metabolic panel, complete blood count, hemoglobin A1c, lipid profile, thyroid function tests, iron studies, vitamin D level, and vitamin B12. Additional testing may include liver function studies, coagulation panel, and urinalysis.

Cardiac Screening

Electrocardiogram (ECG) for all patients. Echocardiogram and stress testing as indicated by cardiac history, symptom presentation, or risk factor profile. Cardiology consultation when clinical findings warrant further investigation.

Psychological Assessment

A behavioral health evaluation by a qualified mental health professional is standard practice. This assessment examines readiness for lifestyle changes, eating behavior patterns, history of mental health disorders, substance use, and social support systems.

Nutritional Counseling

Registered dietitian consultation to establish baseline dietary habits, educate the patient about post-surgical nutritional requirements, and begin the pre-operative diet as directed by the surgical team.

Sleep Study

Polysomnography or home sleep apnea testing is recommended for all bariatric surgery candidates. Untreated obstructive sleep apnea increases perioperative risk and should be addressed prior to scheduling the procedure.

Medication Review

A thorough medication reconciliation should be performed before surgery. Key considerations include:

Discontinuing or adjusting anticoagulants and antiplatelet agents per surgical team guidance
Reviewing diabetes medications for potential dose adjustments in the immediate post-operative period
Identifying medications that may need to be converted from extended-release to immediate-release formulations after surgery
Addressing NSAID use, which should be avoided following most bariatric procedures
Evaluating and optimizing psychiatric medications with the prescribing provider

Tobacco Cessation

Patients who use tobacco products should be counseled on cessation well in advance of surgery. Most surgical programs require documented tobacco abstinence for a minimum of six to eight weeks before the procedure. Nicotine use increases the risk of anastomotic leaks, poor wound healing, and venous thromboembolism. Offer pharmacotherapy and behavioral support resources through the primary care office.

Back to PCP Toolkit Post-Operative Care