In bariatric surgery, which perioperative approach is emphasized for better outcomes?

• A. Postoperative care only
• B. Preoperative optimization only
• C. Comprehensive preoperative assessment and postoperative multidisciplinary care with focus on pulmonary hygiene and thromboembolism prophylaxis
• D. No special measures

Answer: (C)

A comprehensive perioperative strategy that combines thorough preoperative assessment and optimization with coordinated postoperative multidisciplinary care yields the best bariatric surgery outcomes. Proper preoperative workup targets the common medical issues that accompany obesity—diabetes, hypertension, obstructive sleep apnea, dyslipidemia, and nutritional deficiencies—and aims to optimize them before surgery. Weight loss efforts before the operation can also reduce liver size and intraabdominal fat, making the procedure safer and easier to perform. A multidisciplinary team—surgeon, anesthesiologist, nutritionist, physical or respiratory therapist, and sometimes behavioral health specialists—ensures that medical optimization, counseling, and planning for postoperative care are aligned.

Postoperatively, focused pulmonary hygiene and measures to prevent thromboembolism are crucial. Obese patients are at higher risk for pulmonary complications after anesthesia, so implementing incentivized spirometry, early mobilization, respiratory therapy, and adequate pain control helps prevent atelectasis and pneumonia. Simultaneously, venous thromboembolism prophylaxis—using mechanical devices and appropriate pharmacologic measures as indicated—reduces the risk of DVT and PE during a period of reduced mobility and prothrombotic state.

In contrast, focusing only on postoperative care without preoperative optimization misses opportunities to address comorbidities before the stress of surgery, while preoperative optimization alone does not sufficiently mitigate perioperative risks that arise after the operation. No special measures would leave known high-risk contributors unchecked.