Perioperative care map improves compliance with best practices for the morbidly obese.
Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients.



A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines.



In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices.



After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes.
Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY.
Ian
I
Solsky
Icahn School of Medicine at Mount Sinai, Surgery, New York, NY.
Alex
A
Edelstein
Icahn School of Medicine at Mount Sinai, Surgery, New York, NY.
Michael
M
Brodman
Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
Ronald
R
Kaleya
Icahn School of Medicine at Mount Sinai, Surgery, New York, NY.
Meg
M
Rosenblatt
Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY.
Calie
C
Santana
Hospitals Insurance Company, New York, NY.
David L
DL
Feldman
Hospitals Insurance Company, New York, NY.
Patricia
P
Kischak
Hospitals Insurance Company, New York, NY.
Donna
D
Somerville
Hospitals Insurance Company, New York, NY.
Santosh
S
Mudiraj
Icahn School of Medicine at Mount Sinai, Surgery, New York, NY.
I Michael
IM
Leitman
Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY. Electronic address: pshamami@montefiore.org.
Peter
P
Shamamian
D002983:Clinical Competence; D019983:Guideline Adherence; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D019990:Perioperative Care / Q000193:education*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'