Transcript Bariatric Surgery Inservice

Weight-Loss (Bariatric)
Surgery
Introduction Seminar
2013
Kaiser Permanente Colorado
Seminar Outline

You will receive information about the
following groups today:




Kaiser Permanente Metabolic-Surgical Weight
Management Team
Kaiser Permanente Nutrition Services
Kaiser Permanente Financial Services
Exempla St. Joseph Bariatric Weight Loss
Surgery Center
Metabolic-Surgical Weight
Management Department
Englewood Medical Office
2955 S. Broadway
Englewood, CO 80113
Franklin Medical Office
2045 Franklin St.
Denver, CO 80205
Rock Creek Medical Office
280 Exempla Circle
Lafayette, CO 80026
Kaiser Permanente
Bariatric Surgeons

Farah Husain, MD

Frank Chae, MD
Bariatric Multidisciplinary Team





Physicians and Physician-extenders (PA &
NP)
Nursing staff
Registered Dietitians
Behavioral health, Psychologists
Management and Administration including:


Financial Services
Member Benefits
Why is obesity a problem today?





Portion distortion
Taking the escalator or elevator instead of
stairs (decrease in physical activity)
Busy lifestyle, prioritizing
Food-filled environment
Relatively sedentary lifestyle now
Who can have bariatric surgery?
Obesity is a complex medical problem



Approximately 100 lbs over ideal body
weight
Body Mass Index >40 and BMI >35 with
certain medical problems (KP guidelines)
BMI Calculator: available online at
http://www.bmi-calculator.net/
Expectations

Predictable, maintained weight loss

One year- 65-70% excess body weight


90% of associated health problems
resolve
Ability to wean off blood pressure and
diabetes medications
Patient Commitment

Commit to lifelong follow up





Regular follow up visits
Regular blood draws
You will need to be on vitamin and mineral
supplements for the rest of your life
Avoid tobacco products lifelong and alcohol for
at least 1 year post-op
Avoid NSAIDS (Motrin, Ibuprofen, Advil, Aleve,
Naprosyn)
Patient Commitment



Adhere to diet (DO NOT “test your stomach”,
see how much you can eat, or try bad foods)
Attend and participate in support group
meetings regularly after surgery (sustained
weight loss is connected to participation)
Exercise regularly- raise heart rate, sweat,
sustain this for at least 30 minutes, 4-5 times/wk
Exercise


Physical therapy consults available
Ideas:




Strength training
Dance
Walk
Water


Walk in pool/aerobics/swim
Stretch, yoga
Metabolic (Medical) options
Provides medical management for weight
loss for members with BMI greater than 30





Patients before, during and after bariatric
surgery
Patients in Optifast® weight loss program
Patients taking prescribed medication for weight
loss
Patients requiring medical management of
medical conditions during weight loss
Patients with metabolic conditions that affect
nutrition
The KP Bariatric Pathway
7 Steps to Surgery

Step 1: Attend Weight-Loss Surgery Seminar –
( Please call our office if your interest in weight loss
surgery changes, and/or prior to losing KP insurance).

Step 2: Wait-list 7-8 months


Step 3: Medical and Behavioral therapy intake visits





Optimize medical problems, complete preventative health
screening
Are you fit for surgery? BMI <60, no smoking
Step 4: Surgery Connections Classes 6 wks
Step 5: Surgery pre-op appointment
Step 6: Surgery will be scheduled within 45 days
of completing classes
Step 7: Surgery
Our 6-week program







Learn about surgery and how to succeed
Understand past experiences with weight
Identify triggers for weight gain
Engage in behavior changes
Learn to get through challenges
Manage body weight
Learn what you can and should eat post
surgery
Nutrition

It is mandatory that you attend all of the
6-week Surgery Connections classes prior to
surgery.
The cost for Surgery Connections is $80 to be paid up-front.
Surgery Connections classes are located at East, Englewood, Lakewood
and Westminster.

Attending Support Groups is extremely
important following surgery to ensure your
success and well being.
Support groups for Post-Surgery are offered at St. Joseph's Hospital twice
a month and we also offer a support group via webinar once a month.
Eating after surgery

All surgeries require:
3 high protein, low fat meals
 Avoid all sugar (even alcohol and juice)
 Avoid all carbonated and calorie drinks
 Well chewed, dime sized bites
 Eat very slowly (20 minutes per meal)
You will learn all about how to eat properly post
surgery during your Surgery Connection class.

Nutrition Services

Registered Dietitians specializing in medical weight
management and bariatric surgery are available by
phone or email for specific questions and concerns
before and after surgery.

Call 303-614-1070 to get started on managing your
weight. Kaiser Permanente offers a variety of classes
and resources to assist with lifestyle changes as you
prepare to have weight loss surgery.

Telephone based Health Coaching.
To schedule
an appointment call the
Healthy Living Helpline 1866-402-4320.
Cost: Free
Questions?
Financial Services
Contact a financial counselor prior to surgery
for all financial questions and advice
(303) 338-3025
EXEMPLA
Saint Joseph Hospital
The Bariatric Weight Loss Surgery
Center
Midtown Medical Building
1960 N. Ogden Street, Suite 550
Denver, CO 80218
Phone: (303) 318-3240
The Bariatric Weight Loss Surgery Center at
Exempla Saint Joseph Hospital

Della Goedert, RN


Bariatric Coordinator
Vicenta Correa,

Patient Coordinator



Bariatric Center of Excellence status achieved in
2009
More than 1000 bariatric surgeries performed at
ESJH since 2005
More than 400 bariatric procedures performed in
2011



Roux-en-Y
Gastric Sleeve
Gastric Banding
Before your surgery…
Appointment with ESJH Patient Coordinator

In addition to your PEEC appointment at Kaiser, you will be seen in the
Bariatric Weight Loss Surgery Center at ESJH prior to your surgery.
This appointment will include:

Pre-registration and insurance verification

Collect hospital co-pay, co-insurance and/or deductible
Appointment with ESJH Bariatric RN

Pre-Operative teaching, verify medical information

Medications, allergies, medical history
Hospital Costs
Estimate out-of-pocket expense =
$8,000 to $15,000



This is an estimate of the out-of-pocket
expense for bariatric patients.
Your cost may vary depending on your
bariatric coverage.
Most members are responsible for a co-pay,
co-insurance and/or deductible for the
hospital, surgeon and anesthesiologist.
Hospital Costs

Bariatric coverage is determined by the
Bariatric Benefit on your Kaiser Plan

Co-insurance can range from 10% to 50%,
Deductibles vary by plan


KP Financial Services (303-338-3025) can help
you understand your bariatric benefits
ESJH Patient Coordinator (303-318-3241) can
help you understand the hospital charges and
billing process
Deposits and Payments

Deposits for facility fee


ESJH protocol is to collect 25% towards total
patient out of pocket cost.
Payment plans are available



Interest free, monthly installments
Payment plan up to 24 months
Financial Counselor available at ESJH
Questions
Bariatric Surgery Today
Three Types of Procedures We Perform
Restrictive
Restrictive
Adjustable Band
Gastroplasty
Sleeve
Gastrectomy
Combination
Roux-en-Y
Gastric Bypass
Pros/Cons

Lap Band





Fastest, least invasive procedure
Requires frequent post-op adjustments
High reoperation rates >20%
Lowest weight loss
Gastric bypass


Well-defined results, best weight loss
Longer surgery, more complications
Pros/Cons

Sleeve




Shorter surgery time than bypass
No malabsorption
Similar complications to bypass
Unclear long-term ultimate weight loss (thus
far approx 60% EBW)
Risks of surgery
Lap Gastric Bypass
Mortality
<1.0%
Leak Rate
<3.0%
PE Rate
<1.5%
Hernia Rate
<1.8%
Wound Infection Rate
<2%
Schauer and Ikramuddin, Surg Clin North Am, 2001 Oct;81(5):1145-79;
Kral, Clin Per Gastroenterology 2001 Sep/Oct:295-305; Nguyen et al. Ann Surg 2001; 234(3)279-291
Complications can happen!









Dehydration
Leak of gastric fluids
Bowel obstruction / blockage
Stricture- narrowing of stomach
Stomach ulcer
Band problems
Infection
Chronic pain
Prolonged nausea and vomiting
Appointments for Weight Loss
Surgery






Week of surgery: RN Phone call
1 month after surgery: visit with a provider
3 months after surgery: visit with a provider,
Mental Health provider, dietician and lab work
6 months after surgery: lab work, support
group
1 year after surgery: visit with a provider, lab
work
Annual lab work through your PCP
Questions?