title: A postoperative nutritional consult improves bariatric surgery outcomes.
abstract: BACKGROUND
  Bariatric surgery is the most effective treatment for obesity. Guidelines for optimizing postoperative care are emerging, and roles of the surgeon and registered dietician (RD) have opportunities for coordination.
  
  
  OBJECTIVE
  The study objective was to better define the appropriate guidelines for postoperative care by investigating whether a combined surgeon and RD follow-up for the initial postoperative visit within 2 to 6 weeks after surgery improves patient outcomes.
  
  
  METHODS
  The setting was an accredited bariatric hospital in an academic setting.
  
  
  METHODS
  A retrospective analysis of a prospective database was performed on patients who underwent bariatric surgery and were followed up by either a surgeon alone or by a surgeon and RD for initial postoperative visit.
  
  
  RESULTS
  There were 302 patients in the surgeon follow-up group and 268 in the RD follow-up. Patients in the RD follow-up group had significantly fewer readmissions due to dietary-related problems (9 versus 0; P = .004), more favorable 3-month change in serum thiamine (-30.5 versus-4.04; P = .002), high-density lipoprotein (-3.42 versus-1.67; P = .053), and triglycerides (-17.5 versus-31.5; P = .03), and trended lower number of minor complications (16 versus 6; P = .08). No significant differences in percent excess weight loss were observed at all time points after surgery. Multivariate logistic models controlling for demographic features found that RD follow-up predicted 3-month increase in thiamine (odds ratio = 2.49; P<.000) and high-density lipoprotein cholesterol (OR = 1.73; P = .01), and decrease in total cholesterol (OR = 1.58; P = .03) and triglycerides (OR = 1.55; P = .03).
  
  
  CONCLUSIONS
  Follow-up with a surgeon and RD for the initial postoperative visit may help improve patient outcomes.
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: Trit
authors.initials: T
authors.lastname: Garg
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: Kristine
authors.initials: K
authors.lastname: Birge
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.lastname: Ulysses Rosas
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: Dan
authors.initials: D
authors.lastname: Azagury
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
authors.affiliation: Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California. Electronic address: morton@stanford.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000379:methods*; D064686:Nutritionists / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000178:diet therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric; Nutrition; Obesity; Outcomes; Readmissions; Registered dietician; Surgery