Raising the Standard: The Role of the Clinical Pharmacist in the Care of the Bariatric Surgery Patient

Over the past decade, the number of bariatric surgeries performed annually in the United States (US) grew significantly, increasing approximately 60 percent from 2011 to 2019.¹ Bariatric surgery is expected to undergo continued growth in years to come, increasing the need for the multidisciplinary approach these patients require.²

Patients are considered for bariatric surgery based on body mass index (BMI) and coexisting conditions.³ Secondary to severe obesity and multiple chronic conditions, these patients can be on complex medication regimens that require adjustments throughout the bariatric surgery journey. Furthermore, patients undergoing bariatric surgery are subject to malabsorptive changes, not just for vitamins and minerals, but also medications. Oral medications are subject to variability in disintegration, dissolution, permeation, absorption, and metabolism via anatomical surgical changes and postoperative weight loss. Postoperative metabolic changes can complicate management of these patients’ medication regimens.⁴ As part of a multidisciplinary bariatric team, clinical pharmacists play a unique role in promoting patient safety and adherence by recognizing potential pharmacokinetic changes induced by surgery and how to adjust medication regimens to overcome those challenges.  

Implementation of clinical pharmacy services in bariatric surgery programs has been found to reduce medication errors, promote cost-avoidance, and lead to positive patient-reported outcomes.^5,6 Though job descriptions might vary, limited literature published to date shows similarities in the services pharmacists provide in bariatric surgery programs.⁷ This article describes pharmacist roles on the bariatric surgery team based on more than a decade of experience at CHI Health Immanuel, a community hospital program in Omaha, Nebraska. The activities of the bariatric pharmacist are designed to promote quality improvement and patient safety. Because clinical pharmacy services for bariatric programs are not standardized, activities might differ at other institutions.