Wouter Leclercq

Preoperative education and informed consent in young adults undergoing bariatric surgery: Patient perspectives on current practice 87 5 DISCUSSION Received preoperative counseling and recall of preoperative provided information were focus of the current study. The received education regarding positive effects of bariatric surgery was deemed sufficient. It is known that patients will forget several aspects about the SIC postoperatively. 11 Madan et al. concluded that at >1 year postoperatively only 36% of the patients could answer all questions correctly regarding the preoperative information. 19 Especially the negative aspects are easily forgotten, but also less emphasized, while patients express the need for education about these negative aspects. In our cohort, 24/27 patients could not recall one or more complications and the negative effects were less recalled. Physicians should educate patients more about the negative effects of a treatment. Recollection of preoperative information might be biased by the occurrence of complications and/or by the participant’s satisfaction on the surgery itself. Saigal et al. however found no significant difference between recall of specific complications experienced versus those not experienced in patients undergoing adult spinal deformity surgery. 20 In our study, patients with a complicated course showed more knowledge of the postoperative complications abdominal (wall) pain and gallstones. More emphasis on postoperative complications in general and on specifically abdominal (wall) pain and gallstones is recommended. The SIC process should be more age specific and personalized. Bariatric surgery requires a lifelong lifestyle adjustment. In a turbulent young adult stage of life, complying with all these adjustments might be challenging, especially in the long-term. Young people are known to show worse adherence to the postoperative outpatient hospital care and the postoperative behavioral adjustments. 7 Taube-Schiff et al. reported the need to connect to other individuals that had gone through the surgical program and several participants also noted that having other young adults in the patient to patient support groups would have been beneficial. 9 In this study a strong request was made by the young adults for more education regarding fertility, contraception and menstrual disorders and for more patient to patient support with other young adults. Next to this, over one third of the patients found it very difficult to give consent for the bariatric surgery, although the law considers a young adult capable of making independent decision, which indicates that there might be a need for a coach to make an informed consent decision. The preoperative education and informed consent process is an essential step in the treatment process of bariatric surgery. Data from individual practice or larger published studies regarding outcomes after bariatric surgery helps physicians to optimally inform