Évaluation préopératoire des facteurs de risque de complications après chirurgie bariatrique

The decision to perform a bariatric surgical procedure, the conclusion of a clinical pathway in which management is individually adapted to each patient, is taken after multidisciplinary consultation. Paradoxically, the patients who would most benefit from surgery are also those who have the highest operative risk. In practice, predictive factors of mortality and severe post-operative complications (Clavien-Dindo > III) must be used to evaluate the benefit/risk ratio most objectively. The main risk factors are age, male gender, body mass index, obstructive sleep apnea syndrome, insulin resistance and diabetes, tobacco abuse, cardiovascular disease, ability to lose weight before surgery, hypoalbuminemia, and functional disability. Routine pre-operative evaluation of high peri-operative risk patients provides the attending physician with information to: (1) correct several of these risk factors before surgery and thereby limit the operative risk, (2) orient the patient to a less risky surgical procedure and/or to a facility with a more adapted technical capacity, as necessary; (3) contra-indicate the operation if the risks exceed the expected benefits. All in all, this pre-operative evaluation combined with management of co-morbidities contributes to decrease the risk of post-operative complications and to improve the overall management of obese patients.