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CBR AM: Patient Assessment, Selection, and Preoperative Preparation

CBR AM · Work through your exam, one topic at a time.

All guide sections

Patient Assessment, Selection, and Preoperative Preparation

What this domain tests

This domain covers the front door of the program: who is a candidate, what the medical, nutritional, psychological, and surgical evaluations must document, and which preoperative measures actually change outcomes and justify informed consent. Expect questions on current eligibility criteria, absolute versus relative contraindications, required laboratory work, and the specific preparations that must be verified before scheduling.

Eligibility and contraindications

  • BMI ≥35 kg/m² regardless of comorbidity, or BMI 30–34.9 with type 2 diabetes (2022 ASMBS/IFSO).
  • Age is not an absolute limit; adolescents and older adults are judged on physiologic reserve, goals, and support.
  • Absolute barriers: active uncontrolled substance use, inability to give informed consent, untreated psychosis.
  • Relative barriers: binge eating disorder, poorly controlled depression, smoking, and a documented history of nonadherence - these are treatment targets, not automatic exclusions.

Required preparation

  • Smoking cessation at least 6 weeks before surgery: nicotine drives marginal ulcers, pulmonary complications, and poor wound healing.
  • A 2-week very-low-calorie diet to reduce liver volume and improve exposure.
  • Baseline labs: CBC, ferritin and iron studies, B12, folate, 25-OH vitamin D, PTH, calcium, albumin, A1C, lipids, TSH; H. pylori testing where indicated.
  • VTE risk scored (for example Caprini) with mechanical and pharmacologic prophylaxis planned.
  • Contraception for 12–18 months after surgery.

Worked example

A 41-year-old woman has BMI 32.8 and type 2 diabetes with A1C 7.4%. PHQ-9 is 4 and she denies binge eating. She smokes half a pack daily. Reasoning: she meets current criteria because BMI 30–34.9 with type 2 diabetes qualifies, so she is a candidate. Smoking is a modifiable relative contraindication, so the program sets a quit date and verifies abstinence with cotinine before scheduling. Her A1C is acceptable at most programs, so it does not delay her.

Traps

  • Applying the older 1991 NIH thresholds and wrongly excluding BMI 30–34.9 with diabetes.
  • Treating binge eating disorder as an automatic exclusion instead of a condition to treat first.
  • Clearing a patient with an A1C of 10% or active alcohol use on the assumption that surgery will fix it.