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Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery.
Surg Obes Relat Dis. 2010 May-Jun; 6(3):274-81.SO

Abstract

BACKGROUND

Psychological evaluations are used to ascertain patient suitability for bariatric surgery and to challenge their ability to comply with therapy. The modern paradigm of obesity includes a neurobiologic component working in parallel with the limbic system of appetite and reward. To achieve the goals of surgery, an evaluation of the psychological fitness of the patient is often included in the clinical pathway. We present a psychological classification system with the goal of integrating the psychological factors into patient treatment.

METHODS

All patients (Roux-en-Y gastric bypass, n = 1814; laparoscopic adjustable gastric banding, n = 589) were evaluated using psychological testing/interview and assigned to groups 1-4 before surgery. The group 1 patients (n = 788; 32.8%) did not necessitate intervention, group 2 (n = 1110; 46.2%) were requested to attend the support group, groups 3A (n = 394; 16.4%) and 3B (n = 111; 4.6%) required intervention to continue to surgery, and group 4 patients were not recommended for surgery. The main outcome measures, including complication, readmission, and reoperation rates, were analyzed for differences among the psychological groups.

RESULTS

After comparing the outcome measures between each classification, no significant differences were found in the major complication rates, readmissions, reoperations, or length of stay among the groups. Groups 3A and 3B were able to achieve similar rates of success, despite their psychosocial impairment at the initial evaluation.

CONCLUSION

The assignment of a psychological classification can facilitate bariatric team recognition of the unique psychological factors that affect the success of surgery. Assessing the patient's psychological composition and addressing potential psychosocial barriers before surgery can increase the positive long-term outcomes and reduce the incidence of complications after bariatric surgery.

Authors+Show Affiliations

Scottsdale Bariatric Center, Scottsdale, Arizona 85258, USA. blackstonemd@mac.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20510290

Citation

Blackstone, Robin P., et al. "Psychological Classification as a Communication and Management Tool in Obese Patients Undergoing Bariatric Surgery." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 6, no. 3, 2010, pp. 274-81.
Blackstone RP, Cortes MC, Messer LB, et al. Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery. Surg Obes Relat Dis. 2010;6(3):274-81.
Blackstone, R. P., Cortes, M. C., Messer, L. B., & Engstrom, D. (2010). Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 6(3), 274-81. https://doi.org/10.1016/j.soard.2010.02.034
Blackstone RP, et al. Psychological Classification as a Communication and Management Tool in Obese Patients Undergoing Bariatric Surgery. Surg Obes Relat Dis. 2010 May-Jun;6(3):274-81. PubMed PMID: 20510290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery. AU - Blackstone,Robin P, AU - Cortes,Melisa C, AU - Messer,L Buddy, AU - Engstrom,David, Y1 - 2010/02/19/ PY - 2009/08/05/received PY - 2009/12/11/revised PY - 2010/02/01/accepted PY - 2010/6/1/entrez PY - 2010/6/1/pubmed PY - 2010/9/30/medline SP - 274 EP - 81 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 6 IS - 3 N2 - BACKGROUND: Psychological evaluations are used to ascertain patient suitability for bariatric surgery and to challenge their ability to comply with therapy. The modern paradigm of obesity includes a neurobiologic component working in parallel with the limbic system of appetite and reward. To achieve the goals of surgery, an evaluation of the psychological fitness of the patient is often included in the clinical pathway. We present a psychological classification system with the goal of integrating the psychological factors into patient treatment. METHODS: All patients (Roux-en-Y gastric bypass, n = 1814; laparoscopic adjustable gastric banding, n = 589) were evaluated using psychological testing/interview and assigned to groups 1-4 before surgery. The group 1 patients (n = 788; 32.8%) did not necessitate intervention, group 2 (n = 1110; 46.2%) were requested to attend the support group, groups 3A (n = 394; 16.4%) and 3B (n = 111; 4.6%) required intervention to continue to surgery, and group 4 patients were not recommended for surgery. The main outcome measures, including complication, readmission, and reoperation rates, were analyzed for differences among the psychological groups. RESULTS: After comparing the outcome measures between each classification, no significant differences were found in the major complication rates, readmissions, reoperations, or length of stay among the groups. Groups 3A and 3B were able to achieve similar rates of success, despite their psychosocial impairment at the initial evaluation. CONCLUSION: The assignment of a psychological classification can facilitate bariatric team recognition of the unique psychological factors that affect the success of surgery. Assessing the patient's psychological composition and addressing potential psychosocial barriers before surgery can increase the positive long-term outcomes and reduce the incidence of complications after bariatric surgery. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/20510290/Psychological_classification_as_a_communication_and_management_tool_in_obese_patients_undergoing_bariatric_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(10)00074-2 DB - PRIME DP - Unbound Medicine ER -