Table 4 Major obesity-related conditions and pertinent studies

Cardiovascular

• ECG if cardiac disease is suspected

Coronary artery disease

• Use validated tools to estimate risk of perioperative MACE

• If risk of MACE ≥ 1 % and functional status is poor, consider stress testing

Pulmonary hypertension

• Consider right ventricular hypertrophy, pulmonary hypertension if ECG shows right axis deviation, right bundle branch block

• Echocardiogram to assess right and left ventricular function & morphology, valvular morphology, estimate pulmonary artery pressure

• Right heart catherization

Congestive heart failure

• Chest radiograph

• Echocardiogram

Respiratory

Dyspnea

• Chest radiograph

Asthma

• Pulmonary function testing not recommended for routine screening

Obstructive sleep apnea

• Screen for OSA with history, physical exam, validated screening questionnaire

• Consider polysomnogram

• Consider initiating CPAP/biPAP preoperatively

Hypoventilation syndrome

• Arterial blood gas

Gastrointestinal

GERD

• Upper endoscopy

• 24-h pH monitoring

• Esophageal manometry

• Barium swallow (upper gastrointestinal series)

NAFLD

• Liver function tests (LFTs)

• Triglyceride level

• Liver ultrasound if LFTs elevated or symptomatic biliary disease

H. Pylori

• Stool antigen test

• Urea breath test

• Endoscopy – rapid urease test

Endocrine

Diabetes mellitus

• Measure Hgb A1c

• Optimize glycemic control

Hematologic

VTE

• Assess VTE risk: degree of obesity, age, history of previous DVT or hypercoagulable state, history of malignancy, immobility

Psychologic

• Psychosocial-behavioral evaluation

Depression / anxiety

• Identify patients at risk for suicide

Binge eating disorder

Nutritional

• Iron studies, B₁₂, folate, 25-hydroxyvitamin D

• Electrolytes, calcium, magnesium, phosphate levels