Interview with Robert Cunningham: The Post-Discharge Gap: Why the First Ten Days After Surgery Still Break Down

What really happens after a patient leaves the hospital—and why does so much still break down in the first 10 days? In this episode, Dr. Robert Cunningham, a fellowship-trained bariatric and metabolic surgeon, shares what it takes to build a surgical program from the ground up in one of the most underserved regions in the Midwest. From launching a de novo bariatric program at Methodist Jennie Edmundson to navigating real-world access challenges, he offers a candid look at the operational and human realities behind growth. The conversation goes beyond program building. Dr. Cunningham breaks down how GLP-1 medications are reshaping—and in some cases complicating—the surgical pipeline, and why the biggest gaps in care still happen after discharge. Despite advances in technology, the first week at home remains one of the most vulnerable periods for patients. This is a practical, on-the-ground discussion for health system leaders, surgeons, and operators focused on access, outcomes, and the parts of recovery that clinical pathways and digital tools still struggle to solve. 0:00 Introduction to NovaNav 0:55 Guest Introduction: Dr. Robert Cunningham 1:00 Dr. Cunningham's background: Ireland, MGH, and UNMC 3:40 Fellowship training at Geisinger and entering practice during COVID 4:15 Launching the bariatric program at Methodist Jenny Edmondson 5:52 Technology's impact on surgical safety: AI image overlays and intraoperative guidance 7:21 Bile duct injury and the holy grail of cholecystectomy safety 9:07 Molecules and nerve identification for inguinal hernia repair 10:25 Patient-facing technology: what patients actually experience 12:13 Immediate result release in patient portals and the cancer diagnosis problem 15:48 The host's personal experience: discharge instructions and post-op confusion 17:55 Where perioperative navigation platforms fit into the care continuum 20:46 Building the bariatric program: institutional support and proforma negotiation 23:55 Program components: dietitians, physical therapy, psychiatric evaluation 26:07 First surgical outcomes and the role of the program coordinator 27:32 Post-discharge follow-up, phone calls, and the literature on outcomes 29:13 GLP-1 medications and their effect on bariatric volume 35:20 Cost analysis: surgery versus lifelong GLP-1 therapy 36:41 Rural healthcare, critical access hospitals, and workforce challenges 39:06 The limits of AI and the risks of removing human interaction from care 43:00 Loneliness, social isolation, and surgical logistics for older patients 44:17 Advice for surgical residents: communication as the defining non-technical skill 48:40 The full spectrum of communication: bad news, colleagues, and conflict 50:30 Malpractice data and surgeons who communicate well 51:44 Closing remarks