Background

Psychological evaluations are a routine part of patients’ pre-bariatric surgery preparation and are guided by 2016 ASMBS guidelines. While validated behavioral health (BH) complexity rating systems exist, systems that utilize current guidelines are needed. This study discusses the creation and implementation of a BH complexity rating system and examines the relationship between patient complexity and early postoperative outcomes.

Methods

Complexity ratings were defined as high, moderate, and low and were given by the BH clinician during the initial evaluation. Ratings were derived from patients’ electronic medical record (EMR) from 1/2018 – 9/2022. Patient demographic information and return visits [30-day hydration appointments, emergency room (ER) or hospital observation, and hospital readmission post-bariatric surgery] were derived from the EMR.

Results

BH and bariatric surgery team members anecdotally reported value in the BH complexity rating system. Overall (N = 716), 62% of patients were low, 32% moderate, and 6% high BH complexity. Patients with greater preoperative excess body weight were more likely to be complex (p < .05). No significant relationships emerged between BH complexity and 6- and 12-month weight loss, hydration appointments, or 30-day hospital readmissions. ER or hospital observations visits were more likely among those of higher complexity (p < .0001).

Conclusions

Use of a BH complexity rating system may enhance consistency of care provided, aid in standardization of recommendations, and improve multi-disciplinary team discussions for complex patients. Using complexity scores to modify pre-operative preparation processes or post-operative care may enhance post-operative outcomes.