I. Solsky2, A. Edelstein1, P. Shamamian2, M. Brodman1, R. Kaleya4, M. Rosenblatt1, C. Santana2, D. L. Feldman3, P. Kischak3, D. Somerville3, S. Mudiraj3, I. Leitman1 1Mount Sinai School Of Medicine,Surgery,New York, NY, USA 2Albert Einstein College Of Medicine,Surgery,Bronx, NY, USA 3Hospitals Insurance Company,New York, NY, USA 4Maimonides Medical Center,Brooklyn, NY, USA
Introduction: The impact of morbid obesity in complicating perioperative management is becoming increasingly recognized. Best practice guidelines have been published but are typically followed in bariatric surgical patients only. Little is known regarding physician awareness of and compliance with these clinical recommendations for non-bariatric surgical procedures. The present study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese surgical patients.
Methods: A care map outlining best practices for morbidly obese surgical patients was distributed to all surgeons and anesthesiologists at four urban teaching hospitals in 2013. Pre and post-intervention surveys were sent to all participants in 2012 and again in 2015 to evaluate changes in clinical practice. A chart audit was also performed post-intervention to determine physician compliance with the distributed best practice guidelines.
Results: 567 physicians completed the survey in 2012 and 375 completed it in 2015. Post-intervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese surgical patients to comply with best practices preoperatively (89% vs. 59%), intra-operatively (71% vs. 54%), post-operatively (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 four hospitals combined found that 167 (98%) cases were compliant with best practices.
Conclusion: After distributing the morbid obesity perioperative care map, the percentage of surgeons and anesthesiologists 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.