Many bariatric programs have implemented pre-surgical psychosocial evaluations (PSE) in accordance with guidelines and consensus statements from national organizations. The utility of PSE for screening bariatric patients and identifying risk factors for poor outcomes remains unclear. Our study aimed to evaluate the effectiveness and utility of routine PSE performed at our institution.
This is a retrospective review of patients who underwent bariatric surgery between 2000 and 2017. Patients underwent PSE by a licensed behavioral health clinician and a post-operative telephone questionnaire. The PSE and post-operative questionnaire were analyzed and compared for identification of high-risk patients and concordance with postoperative psychosocial care requirements.
Of the 272 patients who underwent routine PSE, all (100%) of them were recommended for bariatric surgery. Thirty-nine patients (14%) were recommended for additional postoperative psychosocial counseling, but only 15% of these completed any postoperative counseling/therapy. An additional 12% who were not identified through the PSE prior to surgery subsequently entered psychosocial counseling/therapy postoperatively (Figure 1).Clinicians conducting the evaluations practiced at different institutions, held various credentials (physicians, licensed clinical social workers, licensed professional counselors, doctors of psychology), and utilized different psychosocial assessments.
At our institution, the PSE did not identify any patients that would be prohibited from proceeding with surgery. Patient participation in or the need for postoperative psychosocial care was not reliably identified through the PSE process. Furthermore, PSE did not change the clinical course of any study participants. There may be limited benefit of routine universal PSE in the bariatric population.