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‘Returning to surgery’ – the views of bariatric and metabolic experts

Tue, 08/04/2020 - 15:05
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As bariatric and metabolic surgery restarts across the world, Bariatric News spoke to past IFSO President, Kelvin Higa about how the bariatric community can safely resume surgery... 

1. What have been the most important changes you have developed at your centre to the ‘bariatric patient pathway’ to ensure the safety of both the patient and bariatric and metabolic specialists?

We have transformed to almost 90% telehealth visits. Of course, we still need to see patient in person, but most of our initial evaluations, follow ups, nutritional and psychological counseling can be done using video platforms.  Patients seen in the office are screened by history as well as temperature and are required to wear masks. Our staff use masks and gloves and disinfect all touch points after every encounter.  Every patient is screened prior to surgery with exposure history and PCR testing.  In the office, we are practicing distancing and hand washing techniques.

2. As your centre returns to surgery, have you prioritized your bariatric patients, and if so, on what basis (urgency, low risk ie. age, low-BMI)?

The prioritization changes based on the availability of resources. In the beginning, when PPE and ICU beds were not scarce, we tried to service the higher risk patients, those who’s risk factors would increase in the time we waited. Then, as the wave of patients impacted our hospital resources, we prioritized low risk, quick discharge patients. However, impending lack of medical health insurance was always a big factor. Many patients had to endure the mandatory six-month medical weight management barrier required by many insurance companies without any evidence base, now on the verge of losing their coverage because of loss of their jobs due to economic realities of the COVID-19 pandemic. Many of these patients would not have access to treatment in the future and therefore should be a priority.

3. What do you believe are the most important lessons the bariatric specialty must learn from the from COVID pandemic?

Though often treated as outsiders, we are very much part of the medical community and must share in the responsibility of providing care and resources to our communities. This often means sacrifice, but there is no one isolated from this pandemic.

‘Returning to surgery’ – the views of bariatric and metabolic experts
Kelvin Higa

We must also continue to advocate for our patients. Often because of bias and ignorance, our surgeries are put on hold, thought of as cosmetic only, compounding the barriers already in place that delay care unnecessarily.  It is our responsibility to make it clear that our surgeries are not elective, but medically necessary time-sensitive as is advocated by the ASMBS.

In these unprecedented times, it is sometimes difficult to be optimistic about our future.  But I think the future is bright and this crisis has forced us to evolve faster than we would have ordinarily. Embracing tele-medicine and diversifying our delivery of service to include short stay or out-patient procedures can only enhance our ability to treat and care for more patients, with greater efficiency. 

Finally, “carpe diem”, but “quam minimum credula postero”: Sieze the day, but fear the future. 

The 'Return to work' survey and interviews with bariatric and metabolic specialists were carried out in partnership with Medtronic Inc.