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In Reply: Dr Schumman appropriately points out the vital contribution of the anesthesiologist and perioperative care team in the safe management of patients undergoing bariatric surgery. Metrics of quality related to all aspects of preoperative, perioperative, and postoperative care for this high-risk group of patients will be essential in improving the safety and outcomes associated with bariatric surgery. Questions regarding the most appropriate anesthetic agents, techniques for airway management, and the role of the intensive care unit have yet to be addressed in a rigorous fashion. An ongoing evaluation of bariatric surgery (Longitudinal Assessment of Bariatric Surgery¹; funded by the National Institutes of Health) aimed at addressing many of these and other issues is under way and should provide clinicians and quality-improvement experts with some of the evidence needed to help guide practice.

Drs Blackburn, Hutter, and Jones mention the multidisciplinary quality improvement effort in bariatric surgery developed in . . . [Full Text of this Article]

David R. Flum, MD, MPH
daveflum@u.washington.edu
Department of Surgery
University of Washington
Seattle

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