2004 Papers - Kazigo


Practice Pattern Survey of Preoperative Evaluation amongst Surgeons and Psychologists involved in Bariatric Surgery at Army Hospitals

CPT Nakizito Kazigo, MD
CPT Marc Herr, MD
CPT Jason B. de Leeuw, Psy.D.
MAJ Jay M. Earles, Psy.D.
MAJ Mathew Chung, MD, FACS
MAJ Stanley M. Zagorski, MD, FACS
Tripler Army Medical Center


Purpose: To gather information concerning the preoperative psychological evaluation and selection of patients undergoing Gastric Bypass at US Army Facilities.

Methods: A standard survey was sent to surgeons and mental health providers who participate in bariatric surgery at US Army hospitals. A paired t-test was used to compare differences between surgeons and psychologist responses. A p value < 0.05 was considered significant.

Results: Thirteen surgeons and eight psychologists responded to the survey. Most surgeons (83%) utilized preoperative psychological screening. No standard method of evaluation amongst psychologists was reported with patient interview and personality testing being the most common. Surgeons and psychologists differed on the importance of several aspects of the initial preoperative psychological evaluation (See Table). Surgeons felt that the strongest contraindications for surgical therapy were: inappropriate motivation for surgery (58%), unrealistic goals (58%), maladaptive coping strategies (42%), and inadequate informed consent (42%).

Conclusion:While generally utilized, preoperative objective evaluation of the bariatric patient is not universally performed. There seems to be no standard methods of evaluation with a variety of methods employed. Surgeons’ and psychologists’ opinions differ as to the importance of several aspects of the preoperative evaluation. Continued dialogue is needed to improve the effectiveness of preoperative evaluation and screening. Further studies to evaluate preoperative evaluation, and its correlation with and postoperative outcomes, are needed.