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)
St Lukeís/Roosevelt Institute for Bariatric/Minimally Invasive Surgery 1111 Amsterdam Avenue, 4W Babcock Bldg New York, NY 10025
(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
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
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)
Harlem Hospital Center 506 Lenox Ave, NY, NY 10037
Lenox Hill Hospital (Manhattan Minimally Invasive and Bariatric Surgery) 110 East 59th Street, Suite 8A, NY, NY 10022
Mount Sinai Metabolic and Bariatric Surgery Center
www.mountsinai.org/MEMIS , call 212-824-2350 or 212-241-3309
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 MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle 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.