Published Aug 29, 2004
For many of us, med-surg is a challenging and exciting area of nursing to work in. I started this thread, because like any good nurse, I would like to learn more and ways other nurses handle things in med-surg. I would like to have a topic started each week that addresses either tough patient situations, problems with physicians, dealing with students, dealing with your nurse manager or clinical issues that were interesting.
We have to be careful about giving to much information, but I thought this would stimulate some interesting discussion.
Who would like to start the initial discussion? I would ask that you start a new thread and entitle it TOPIC OF THE WEEK and then put the topic in the header ..... ok - lets have some fun.
RNPATL, DNP, RN
Wow ... the thread has had 39 views and no one is interested in posting a topic of the week? Surely there is an interesting MS topic to discuss.
Given that we have not had much participation in this thread (we have had 71 views though) - I thought I would start our first topic ....
I would like to discuss bariatric surgery.
It seems that over the last year, bariatric surgery is becoming the wave of the future. Perhaps the reason this is so popular is related to the fact that a number of stars have had the procedure done with a lot of success .... there is AL Roker, a very popular news person, Randy Jackson from American Idol, to name a few.
I know that over the last year, our hospital has started a very busy bariatric program. I think the biggest surprise to me, is that insurance companies are paying for the surgery. While many physicians view the surgery to be medically needed by their patients, there are a lot of insurance companies and HMO's that still view bariatric surgery as elective and cosmetic.
For me, being a nurse and a manager that works with bariatric patients, I do not and have never seen it as cosmetic or elective. For many of these people, I think bariatric surgery is their only hope. Many have significant co-morbities that prevent them from losing weight the way that you and I do.
Nothing makes me happier than to see a post operative bariatric patient going home, with that excitment and anticipation on their face, knowing that when I see them again for their follow-up visit, that they will be thinner and healthier. The course of recovery is very tough for many of these patients, but the benefits in the end are worth it for many of them also!
What is your hospital doing? DO you have a bariatric porgram and if so, how is it handled.
Bariatric surgery is hot because insurance companies are paying for it. Personally , I feel our program does not adequately address psychiatric issues before surgery. The psych eval is supposed to only measure that they understand the procedure and requirements of them. I believe it may be neccesary for the truely morbidly obese. however, I see many patients that I don't think are big enough to warrent having the surgery. Our dietician and Nurse practicioner think that eventually insurance companies will not pay because patients end up gaining weight back. our pts are required to loose 10 % of their weight to qualify----by the time they come back in for surgery, they have gained it back and then some.
nursenatalie, ADN, RN
We have a surgeon who performs bariatric surgeries, he has been put on hold by the hospital. He is in a court battle with the hospital because they are no longer allowing him to perform roux-en-y surgery. There have been three deaths (maybe four) in the past year and I think there is one lady who is still in the ICU hanging on by a thread. The hospital has deemed it too much of a liability to allow this surgery to be performed, not only because of the death rate but MANY complications. We have had two other ladies come back with there stomach leaking/ruptured due to overeating. Seems these people didnt keep eating because they were hungry, they ate for psychological reasons that cannot be eliminated surgically. I realize this surgery is an option for some but not the answer for all obesity. I think the pre-op screening process is too lenient because some of these people think that it is going to be easy and I can tell within their three day stay the ones who will be back.
I agree that the pre-operative screening and psychological aspects need to be explored a lot more than they are doing. I think that a physician that puts together a program that focuses more on the psychological aspect post-op would serve to benefit the patient alot more.
There is a reason that these folks eat and become so obese. While the surgery may alter their bodies ability to take in food, the reason they are eating (much of which is psychological in nature) needs to be addressed so they are successful post - op. Excellent point!
I have seen too many bariatric surgeries lately. They all seem to be those with complications, too. People in due to infection, poor healing wounds that require packing, dehydration, malnutrition, to name a few. I've seen people who weigh 240# on a 5'7" frame. To me, that seems to be an extreme meausure for weight loss. I feel this is used as a miracle diet and is being performed weigh to casually. Eventually, if people remain inactive, they will start to regain some weight back. Stomachs will begin to stretch and expand. I understand there are some that really need this surgery and that's a great way for them to get their obesity under control, but I've seen too many that are lazy and just want a simple fix.
The surgery is far too risky for people to take it lightly. I think every person who desires or needs the surgery to help reduce their weight should be required by law to undergo several months of therapy or more with a positive psych prognosis prior to going through with the operation.
When psyche issues are dealt with and progress is made by the PATIENT, they may realize they don't need the surgery to lose weight, but what they need a continuance of is the therapy treatments to overcome the emotional issues that cause them to overeat or feed their wounded emotions.
This problem is NOT being addressed as seriously as it should be. IMHO!
I think bariatrics is a growing specialty, people have ignored alot of aspects of the morbidly obese too long, such as : Regular standard hospital beds only hold a weight limit of something around 280 lbs (not sure on the exact wt), the one-size fits all gowns- alot of people require two and their sleeves can act as a tourniquet for these pateints. Ever seen anyone bust a regular plastic bedpan? Their dignity can be stripped to the core.
I agree that there should be more counseling and support for those considering or who have had these surgeries, I don't think anyone has these surgeries because they are lazy , perhaps the guidelines should be more strict in some facilities such as a certain BMI or something.
Anyway, just my opinion. I would love to see a floor dedicated to this in our hospital. Patients travel 2 hours at another facility for this surgery and their support groups.
I think it's interesting that, in 30 years of bariatric surgery, there has not been a single study published looking at long-term (greater than five years) morbidity and mortality. The immediately post-op mortality rates vary from 0.5 - 2.5% (depending predominantly on type of surgery), and mortality is often attributed (at least in part) to pre-op condition/BMI. Immediate post-op morbidity rates are around 5 - 8% (once again depending primarily on type of surgery, and with complications often being at least partially attributed to the size of the patient).
Bariatric surgery is certainly touted by the surgeons as a life saving procedure, but there are also no studies looking at long-term health benefits of significant weight loss in the obese - by this I mean that nobody has compared long-term morbidity/mortality rates in formerly-fat people and compared them with never-fat people or with still-fat people.
We do know that fitness is a more accurate determining factor than weight when it comes to overall health and mortality, and there are studies showing that the active fat live longer lives than the sedentary thin, but there's nothing like the promotion for activity that there is for weight loss (surgical and non-surgical).
My hospital used to perform bariatric surgery in the private ward. The patients were (in my admittedly limited experience rotating through there) female, forty, short (five foot four and under) and broad. They were unfit, and unable to sleep supine. I now work in a primarily medial area, and the private ward closed over five years ago; to the best of my knowledge, we no longer perform bariatric surgery. I imagine that's because the rest of the hospital is public and, with our large trauma unit, even non-elective surgery gets bumped half the time.
interesting thread, RNPATL :)
NPR reported on Friday afternoon that CMS has announced that Medicare will stop paying for one specific bariatric surgical procedure because they've decided that the risks are too great to justify the procedure -- but it was just a quick mention in a series of "headlines." No details given, inc. not naming the specific surgery. Did anyone else hear that (or more details since then)?
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