Bariatric Surgery Referrals (click here for pt handout)

†††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††Researched by Dr. E Austin, J Dick, K Patel, S Hasan, T Fuller, D Faleck, and R Brusen, J Suarez

 

Bariatric Surgery General Indications:

 

1) BMI>40 or BMI >35 with serious comorbidities such as DM, OSA, obesity-related cardiomyopathy, or severe joint disease

 2) Acceptable risk for surgery

 3) Motivated and well-informed

 4) Failed previous non-surgical weight loss attempts

 

Bariatric surgery referrals are easy to set up, interested patients just need to go online or call a bariatric center to set up attendance at an online or in person seminar. Prior to choosing a center, the patient should call their own insurance company to ascertain in-network program/surgeons, minimum BMI requirement for surgery coverage, and preop testing coverage. The pre-surgery evaluation process is long, involves multiple appts and can take up to 1-2 years. During this time the PCP should document weight lost efforts and weight trends. Most insurance companies will require PCPs to document failure of weight loss with life style measures to justify surgery coverage, some require monthly weight record x 6 months.

For pre-surgery evaluation, different centers have different testing requirements. Since not all the tests are evidence based, patients may have to pay out of pocket for certain tests(as much as a 1000 dollars)*. Most academic centers facilitate testing they require for patients, a few centers will ask the PCPs to order the required tests. Once the surgery date is finalized the PCP will be asked to perform a formal preoperative consult.   

*Program Requirements are a bit variable spanning endoscopy, stress test, echo, sleep study, psych evals, vitamin testing, H Pylori serology, abd ultrasound...  (~unless covered by insurance, itís about $250 for nutrition and psychological evals)

 

NYC Programs and Referral Information

Click here for pt handout

 

 

St Lukeís/Roosevelt Institute for Bariatric/Minimally Invasive Surgery  1111 Amsterdam Avenue, 4W Babcock Bldg New York, NY 10025

Phone (212) 636-1000 http://www.slrsurgery.org/bariatric-program/bariatric-program.aspx  
Intro evaluation is a
 full day event w seminar in AM meeting w surgeon in PM

 

Montefiore Medical Center (The Center for Weight Reduction  3400 Bainbridge Ave, 4th floor, Bronx, NY 10467

718-920-4800,www.montefiore.org

 

Columbia Presbyterian Center for Metabolic and Weight Loss Surgery  161 Fort Washington Ave NY 10032

Tel: 212-305-4000 or -9506  Website:www.obesitymd.org

Patients attend a seminar and meet with a NP, and will be given a list of required tests and referrals for the PCP to order

  

Weill-Cornell Weight Loss Surgery Program 525 East 68th Street, NY, NY 10021

212-746-5294 www.cornellweightlosssurgery.org

 

NYU- Langone Medical Center 560 1st Ave, New York, NY, 10016

Phone 212-263-3166 www.nyuweightloss.org or

pt will have to attend an info session (http://www.thinforlifeseminars.com/seminars) PRIOR to being able to make an appointment for a surgical consultation  

NYU -Bellevue surgery department (212-562-5555)

 

 

Other Centers

 

Harlem Hospital Center  506 Lenox Ave, NY, NY 10037

212-939-8370 Website:http://www.nyc.gov/html/hhc/harlem/html/services/bariatric-center.shtml

 

Lenox Hill Hospital (Manhattan Minimally Invasive and Bariatric Surgery) 110 East 59th Street, Suite 8A, NY, NY 10022

1-888-949-9344, 212-434-3285,www.nycbariatrics.com

 

Mount Sinai Metabolic and Bariatric Surgery Center

www.mountsinai.org/MEMIS , call 212-824-2350 or 212-241-3309   

 

 

More readings

NIH conference. Gastrointestinal surgery for severe obesity.Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956.

Amount/duration of weight loss is greatest when starting BMI>40.

Maggard MAShugarman LRSuttorp MMaglione MSugerman HJLivingston EHNguyen NTLi ZMojica WAHilton LRhodes SMorton SCShekelle PG. Meta-analysis: surgical treatment of obesity. Ann Intern Med.2005 Apr 5;142(7):547-59.

Mean excess weight loss is 60%. Hyperlipidemia improves in at least 70% of patients. Hypertension resolves in 62% of patients and resolves or improves in 79% of patients.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724

Diabetes resolves in 77% of patients and improves in 86% of patients.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248.