Organising a Bariatic-Center: A Swiss Perspective

Background: The ongoing obesity epidemic leads to increasing numbers of bariatric procedures, which nowadays belong to the most commonly performed visceral surgeries in western countries. To deal with the increasing caseload and to measure up with the expectation of patients and referral doctors, an increasing number of hospitals need to offer such procedures in future. This narrative article summarises requirements, considerations and strategies for organising a modern obesity center based on the example of a swiss tertiary referral center. Objectives: To describe the process needed to organise a multidisciplinary bariatric centre ex novo in a tertiary hospital. To overview the necessary steps a and how to overcome limitations which occur during the process. Methods: The assembly of the bariatric centre started in the second half of 2021 with operational start in 2023. It included the setup of an interprofessional team with endocrinologist, nutritionist and physiotherapists to evaluate people with morbid obesity. Pathways for the preoperative assessment were adjusted to address the specific requirements of bariatric patients. For the hospital stay Enhanced Recovery After Surgery (ERAS)- like pathways were designed. Healthcare professionals were trained for the preoperative assessment, treatment during the hospital stay and postoperative care. Further healthcare professionals were recruited where needed. To achieve this partnerships with already established centres were built up. Current literature was thoroughly studied and requirements of national and international recommendations were fulfilled. In addition, surgical sets for bariatric surgery had to be composed. Appropriate facilities were integrated in the planning of the new building of the hospital. Results: Over a period of about 18 months, we were able to create from scratch a bariatric centre that can cover all aspects of the treatment of patients with obesity, from conservative therapy to bariatric surgery and long-term follow-up. Patients which fulfilled criteria of Highly specialised medicine (esp. revisional surgery, BMI >50kg/m2, age>65 years) where operated in the associated reference center, when indication, was not urgent. Conclusions: Organising a bariatric centre needs a multidisciplinary setup. The core team has to be made up by professionals with experience in the field of obesity and bariatric surgery. Training of all involved professionals and disciplines has to be secured. In this intention, fellowships and cooperations with other bariatric centers are indispensable. Before implementation of bariatric surgery diagnostic flowcharts for preoperative assessment, clinical pathways for the peri- and postoperative care and the follow- up- care have to be defined in a detailed manner.