A Study of Micronutrient Deficiencies after Bariatric Surgery

Background: The United States is plagued with an obesity epidemic, with a resultant growing interest in bariatric surgery. Bariatric surgical procedures alter the GI tract, impeding absorption of micronutrients. Multivitamins (MVI) are an essential supplement after bariatric surgery to prevent nutritional deficiencies and related health problems. However, adherence to MVI supplements, like any medication, can be problematic. The prevalence of nutritional deficiencies after bariatric surgery is not well studied. Purpose: This quality improvement project aimed to evaluate current micronutrient screening practices in a selected bariatric surgical clinic, determine the frequency and type of micronutrient deficiencies by procedure, evaluate adherence of patients to MVI supplementation, and make recommendations to the practice based on findings. Methods: A retrospective chart review was performed on 125 patients from a local bariatric surgery clinic. Pre-surgical and 1-year post-surgical monitoring lab values were compared. A sample of patients were asked to complete the Morisky Medication Adherence Questionnaire (MMAQ) over a 2-month period to assess adherence to the daily MVI recommendation in order to evaluate patient teaching effectiveness. Results: Adherence to MVI supplementation was high in patients who completed the MMAQ. Micronutrient deficiencies varied among patients for whom different surgical procedures had been performed. Data accessibility and management of data for monitoring patients was found to be very problematic, requiring institution of better data management processes. Conclusions: The clinic is in need of several process improvements for data management to improve monitoring of MVI adherence and deficiencies. Patient education appears to be effective based on the very high MVI adherence rates noted in the sample of patients. However, micronutrient deficiencies appear to vary by surgical procedure. The surgeons were receptive to process improvement recommendations.