关键词: 肥胖, 减重外科, 代谢外科, 围手术期外科之家, 并发症, 多学科综合治疗协作组, 预康复

Abstract: Application of perioperative surgical home for bariatric and metabolic surgery        LIANG Hui, LIN Shi-bo. Department of Bariatric and Metabolic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Corresponding author: LIANG Hui, E-mail: drhuiliang@126.com
Abstract    Perioperative surgical home (PSH) is a new clinical concept which redesigns for the patients from preoperative management to postoperative follow-up. It emphasizes the long-term management model from the evaluation of surgical indications to the prevention of perioperative complications. The PSH concept covers the previous concepts of perioperative medicine and enhanced recovery after surgery. PSH concept is more suitable for pre-admission and perioperative management as well as the long-term follow-up of the patients with severe obesity who undergo bariatric and metabolic surgery. PSH concept aims to the whole process management of patients with severe obesity and intervenes in patients' comorbidities before admission, including preoperative weight loss, preoperative cardiopulmonary function improvement, preoperative treatment of diabetes and hypertension. Meanwhile, PSH aims to evaluate the psychological disorders, vitamin deficiency, liver and renal disorders and cardiopulmonary function, and apply the enhanced recovery after surgery postoperatively to guide the optimization of the surgical procedure choice and postoperative rehabilitation guidance. In view of the particularity of bariatric surgery, authors advocate lifelong follow-up, multidisciplinary team intervention, especially the follow-up guidance of endocrinologist, dietician and psychologist. PSH concept can provide whole process multi-disciplinary perioperative management for patients with severe obesity and improve surgical safety.

Key words: obesity, bariatric surgery, metabolic surgery, perioperative surgical home, complication, multidisciplinary team, prehabilitation