Revising risk assessment strategies for perioperative metabolic bariatric surgery
Lisa van Ede-Peelen defended her PhD thesis at the Department of Electrical Engineering on April 17th.
The demand for metabolic bariatric surgery (MBS) is rising due to its proven effectiveness in treating morbid obesity. With this increasing demand and continued advancements in surgical and anesthetic techniques, it has become crucial to re-evaluate risk assessment strategies and the allocation of resources within the MBS care pathway. In her PhD research Lisa van Ede-Peelen focuses on revising risk assessment strategies and integrating innovative technology in the MBS trajectory to optimize patient care and resource utilization.
BMI plays a significant role in preoperative risk management. However, analyses in her PhD research that there’s an increasing trend in ASA-PS III classification for MBS patients in the Netherlands, despite no rise in severe systemic diseases qualifying for this category. Among patients meeting ASA-PS III criteria, those with a BMI ≥40 kg/m² experienced fewer adverse postoperative outcomes compared to those with severe systemic diseases. This discrepancy suggests that the BMI criterion alone may not contribute meaningfully to risk stratification, warranting a review of its role in perioperative evaluation.
Obesity Exposure Score
This research shows that the Obesity Exposure Score (OBES), which incorporates the severity and duration of obesity, offers a more dynamic approach to assessing health risks associated with dysfunctional adipose tissue. OBES has been linked to conditions such as myocardial infarction, atrial fibrillation, and reduced kidney function. OBES could be valuable in perioperative risk assessment and primary care for early intervention in younger patients with lower surgical risks and reduced healthcare costs.
Reviewing discharge criteria
Postoperatively, systematically evaluating patient progress using established discharge criteria is crucial to prevent health issues after returning home. However, discharge criteria also influence the length of hospital stay. In her research Lisa van Ede-Peelen systematically reviewed the literature on the use of discharge criteria by different healthcare providers for MBS patients. She proposes a standardized set based on clinical relevance and scientific evidence. While outpatient treatment is becoming more popular, its implementation remains limited due to a lack of experience and safety concerns.This research demonstrates that outpatient MBS with telemonitoring offers comparable safety and satisfaction outcomes to inpatient recovery. In addition, patients appreciated the autonomy to choose their recovery pathway.
Innovative technology
Telemonitoring innovations, such as the Continuous Registration Early Warning System (CREWS), provide continuous monitoring of vital signs and effective thresholds for detecting complications like bleeding and anastomotic leakage. While false-positive alarms remain a challenge, telemonitoring with CREWS has the potential to enable clinical decision-making by focusing on circadian rhythm restoration and stable surrounding vital signs. This is an example of how technology can play a pivotal role by reducing workload and supporting clinical decision-making. The results from this research can be used as a foundation for further refinement and broader application in diverse patient populations.
Title of PhD thesis: . Promotor: Prof. . Co-promotor: and Marc Buise.