Bariatric surgery has seen a significant increase in popularity over the years, with over 250,000 surgical procedures being performed in the United States alone in 2018, per the American Society for Metabolic and Bariatric Surgery.
This surgery is aimed at helping patients lose excess weight while reducing the risk of weight-related health problems, such as heart disease, stroke, sleep apnea, cancers and more.
Typically, bariatric surgery is recommended for individuals with a body mass index (BMI) of 40 or higher, who have failed to lose weight through conventional methods like exercise and dieting.
Laparoscopic surgery under general anesthesia in a hospital setting is the usual method of performing these surgeries and can take several hours. Post-surgery, patients may be required to stay overnight to allow medical staff to monitor them for complications.
However, a recent study shows that 82% of patients would have preferred to be discharged on the same day of their procedure.
Ambulatory surgery centers (ASCs) have become increasingly popular for bariatric surgery due to cost savings and patient preference. Clinical success is associated with careful patient selection, surgeon experience and the integration of appropriate perioperative care components.
Dr. Nikhilesh R. Sekhar, medical director of the Bariatric and Specialty Surgery Center of Stamford, part of the New York Bariatric Group, said his group has successfully performed over 800 of these procedures in ASCs for the last two years.
He believes patients have better outcomes because they receive more focused attention, are more comfortable and aren’t under anesthesia as long as those who have surgery in the hospital.
“We have robust experience and know that [these surgeries are] safe,” Sekhar told ASC News. “We have criteria established nationally by the Metabolic and Bariatric Surgery and Quality Improvement Program (MBFAQIP). They have strict requirements for what can be done in the surgery center which we follow. It is all rational, justifiable rules that ensure safety.”
The New York Bariatric Group comprises leading surgeons in corrective surgery for morbid obesity.
Its surgeons have performed over 10,000 bariatric procedures and more than 60 years of bariatric surgery experience. The group has locations throughout New York, New Jersey and Connecticut.
“The surgery takes about 20 minutes, and patients are under anesthesia for about an hour [with a sleeve gastrectomy],” Sekhar continued. “We work with an experienced team of anesthesiologists who do technical things on their side to keep the patients comfortable. Patients wake up, are comfortable, and more alert – within 15 minutes, they are up, walking and drinking, and within two to three hours, they are ready to go home.”
The ASC conversation
There is currently a discussion about the possibility of misleading patients into believing that these medical procedures are minor simply because they are carried out in surgery centers.
Yet Sekhar believes this is not the case. He asserts that the success of such procedures is largely due to the experience and expertise of the medical professionals involved.
Sekhar has performed over 3,000 of these surgeries since 2002 and has developed a streamlined approach that minimizes the time patients spend under anesthesia. This, in turn, reduces the likelihood of complications and the need for extended hospital stays.
Sekhar noted that the extended period of time that some patients spend under anesthesia can lead to a range of complications. As a result, patients must be carefully monitored overnight in a hospital setting. However, he argued that patients generally feel more comfortable recovering in their own homes, where they are less likely to be exposed to infections.
“Because of insurance reasons, I still do some surgeries in the hospital,” Sekhar said. “These patients have a slower recovery and more pain. That’s because when a patient goes to a floor in the hospital, they may be cared for by a nurse who has six or more other patients. They don’t get drinking or moving as fast. I’m convinced that early ambulation, active recovery and active return to drinking fluids speed up recovery. I encourage my patients to get quickly back to normal activities.”
Dr. Elizabeth Dovec, founder and CEO of BodyByBariatrics, has been performing various types of bariatric surgeries in ASCs since 2019.
She believes that the shift of these surgeries from hospitals to surgery centers is a positive development for patients.
BodyByBariatrics, based in Florida, provides laparoscopic bariatric surgical weight-loss procedures, such as gastric bypass, gastric sleeve, and revisional bariatric surgeries, to patients aged 15 and above at The Surgical Institute of Central Florida.
Dovec emphasized that performing these surgeries in ASCs can be more efficient and cost-effective, allowing more patients to benefit from them.
“This gives surgery centers and surgeons a new service line while improving access to patients who don’t have insurance or want to self-pay,” she told ASC News. “ASCs keep patients in the U.S. with better standards of care, keep costs lower and make surgery available to more patients.”
The future of bariatric surgeries
Despite the advantage of performing these surgeries in ASCs, Dovec acknowledged that there are still some challenges.
“Payers are still on the CMS inpatient-only list, but these patients are better optimized and prepared than run-of-the-mill ASC patients because they are well screened [for comorbidities] before surgery,” Dovec told ASC News.
The key to success is strong leadership, she added.
“You need a surgeon champion who is engaged and focused. I’ve had the same team every single time,” Dovec explained. “The ASC needs to be a well-oiled machine, and the surgeon has to be the leader of that room.”
From an ASC standpoint, Dovec recommended MBFAQIP accreditation to keep patient safety and quality at the forefront.
“There’s nothing special about bariatrics; it’s all standard-of-care things,” Dovec said. “Make sure the staff is educated. Recognize early complications. Make sure patients are walking, urinating and drinking before going home. Make sure staff has ergonomic training on how to move patients properly.”
According to MBFAQIP, the selection of patients should be a BMI of less than 60 for women and less than 55 for men. Dovec said she thinks surgeons can safely operate on higher BMI patients.
“If all the clearances are there, we can optimize for other medical concerns,” she said. “Over time, we’ll be able to increase the number of those who qualify for this surgery.”
Sekhar agreed.
“I think as time goes on and as we show more safety data, those limitations will expand,” he said. “Higher BMI patients could be done safely, and that should be left up to the surgeon and anesthesiologist’s discretion and not an arbitrary number.”
For Dovec, the bottom line is that bariatric surgeries in ASCs are more than possible – and often preferred by all parties involved.
“I want surgery centers to know they are empowered and can do this,” she said. “It is safe, can be done, and can be made available to more patients.”