Bariatric surgery, weight loss management and related procedures are key offerings for many gastroenterology practices, despite declines in inpatient surgical volumes for the procedure.
As technology continues to expand the capabilities of minimally invasive surgical procedures, more bariatric care will continue to move to the outpatient setting, Catherine Varney, DO, director of obesity medicine for University of Virginia Health in Charlottesville, told Becker’s.
Dr. Varney has served as the university’s inaugural director of the obesity medicine program since 2021, and has been at the cutting edge of the program’s expansion and development — helping secure its triple accreditation in 2023.
“We have our bariatric adult surgery, adolescent surgery and then the obesity medicine arm,” she said. Dr. Varney added that getting the program to where it is today was no easy feat — she and her team spent five years collecting data to present to system leadership to prove the efficacy of building a collaborative program between the obesity medicine and bariatric surgery programs. Dr. Varney works with bariatric surgeons to help prepare their patients for surgery and, primarily, help them manage their health after the procedure.
As a practice within an academic system, Dr. Varney said her team has had access to resources that some standalone facilities may not, such as full-time employees dedicated to data collection and accreditation work, especially that related to quality and outcomes tracking.
Dr. Varney sees bariatric surgery shifting toward the outpatient setting in the near future — but the move will likely be slower for academic facilities.
“I think we’ll be moving to more of an outpatient setting for bariatric surgery as it becomes safer and we can prove that there’s less complications within that first 24 hours because of readmission,” she said. Readmissions or ER visits are key metrics for bariatrics due to the high cost of hospital stays.
Operating room time and payer hurdles are two other challenges that she has faced in developing a bariatric care facility.
“Our only limitation right now to getting people to surgery is OR time,” she said. “That’s the huge rate-limiting set for us. Now, insurance companies have these really arbitrary restrictions of [requiring patients] to have six months of pre-nutritional counseling. The research does not support that those people have better outcomes. It’s beneficial, because it gives us time to adequately prepare patients for what life is like afterward, but it’s not necessary.”
On the flip side, the rapid development of robotics in surgery is opening up a world of opportunity for her practice.
“Robotic interventions have been really revolutionary in decreasing complication bleeds, post-surgical complications and decreasing 30-day readmission rates,” she said. “Revisional surgeries are increasing.”
She said that among those who receive bariatric surgery, about 20% will regain all of their weight back, and about 20% of people will regain up to 15% of what they lost with the initial weight loss from bariatric surgery.
“A lot of these patients’ needs are being met through the anti-obesity medication space, but access remains a big challenge, and that’s where revisional surgery is coming in,” Dr. Varney added.
