Morbidly obese patients often have associated comorbid factors that negatively affect quality of life and often pose a significant risk on a day-to-day basis. Additionally, if unrecognized or inappropriately managed, these factors may be a cause of perioperative complications. Serious medical conditions associated with morbid obesity include cardiovascular, pulmonary, endocrine, metabolic, hematological, and many other diseases (Table 9.2). The availability of consultants and experts in these fields is critical. Specialty physicians should be familiar with the particular pathophysiologic consequences of morbid obesity and should be able to ascertain with a certain degree of confidence the eligibility of candidates to withstand the rigors of major surgery and the required physical demands on patients in the postoperative period. Such consultants should be proficient in adequately preparing patients for general anesthesia, particularly regarding cardiac and pulmonary reserve, and the implementation of special preoperative patient respiratory training.

All patients should undergo extensive evaluation prior to weight-loss surgery. Careful initial history taking and clinical examinations will guide clinicians to diagnose previously unrecognized diseases. Risk factors associated with increased complication rates after surgery were identified in a number of published studies [20–25]. These risk factors include increasing age, male gender, increasing body mass index (BMI), mobility limitations, hypertension, prior history of a venous thromboembolism, coronary artery disease, myocardial infarction within the previous 6 months, angina, prior history of coronary intervention, congestive heart failure, history of stroke, bleeding disorder, smoking history, procedure type, procedure time greater than three hours, obstructive sleep apnea, dyspnea, corticosteroid use, peripheral vascular disease, and liver disease. A center can consider utilizing one or more risk prediction models established to assess the patient’s overall risk associated with metabolic and bariatric surgery. By following appropriate algorithms and considering particular risk factors, many known and undiagnosed conditions can be evaluated, not in an attempt to discourage or prevent operations, but with the goal of fully optimizing surgical outcomes by taking special perioperative precautions and additional supportive measures.

The ability to obtain information instantly on any topic is the result of the tremendous advancements made in the field of cyber technology, which includes access to the Internet, telehealth, and social media. The positive benefits obtained through this achievement, however, present as a double-edged sword. Internet and social media content are not regulated or controlled. For the most part, metabolic and bariatric surgery and obesity-related Web sites provide valuable information, but there are sites that do disseminate erroneous and false information.

For this reason, it is highly advisable to invest in creating electronic on-site resources that accurately reflect the mission and purpose of the bariatric surgery center. A Web site should contain, in lay terms, an explanation of the problems of obesity and the available medical and surgical solutions. It should describe the physical and personal setup of the center and the preoperative and postoperative schedule that patients will follow. Additionally, it would be of great benefit for the Web site to possess the ability to accept initial patient application forms electronically, to be used as a basic screening tool prior to inviting the patient for the educational workshop. A chat room for patients and/or a social media platform where patients could directly contact the surgery center personnel may result in a modality that is more efficient and practical than relying on conventional telephonic arrangements.

Establishing a Health Insurance Portability and Accountability Act (HIPAA)-compliant telehealth network can allow better access to your center and may help improve overall long-term follow-up with your patients. For many rural bariatric centers, patients may need to travel many hours to attend preoperative seminars, educational sessions, support groups, and routine postoperative visits. Patients can simply travel to their local clinic or physician’s office, sign into the telehealth network, and engage in a routine patient–physician encounter with their bariatric surgeon remotely, thus reducing some of the financial burden associated with high costs of fuel and lodging. Avoiding lengthy trips in dreaded weather conditions is an unequivocal benefit of telehealth as well, especially in the wintertime when road conditions may be dangerous and not readily accessible.