Abstract

Abstract

Introduction: Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥ 35 kg/m²), is performed globally over 500,000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations.

Methods: This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol.

Results: Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS.

Conclusion: These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS.

What is already known about this subject

• Rise in Obesity: Since 1990, adult obesity has more than doubled, and adolescent obesity has quadrupled; by 2022, 890 million people were living with obesity, making up 16% of the global adult population.
• MBS Effectiveness: Metabolic and bariatric surgery (MBS) is proven safe and effective for individuals with a BMI of 35 kg/m² or higher, offering metabolic benefits such as type 2 diabetes remission. Over 500,000 MBS procedures are performed globally each year.
• Guideline Variability: Updated guidelines by ASMBS and IFSO in 2022 address patient selection and procedures but lack specifics on referral processes and preoperative management, resulting in inconsistent practices internationally.

What this study adds

• Expert-Curated Guidelines: The study produced 90 expert-curated statements on preoperative management in bariatric surgery, emphasizing the importance of multidisciplinary teams (MDTs) in handling complex patient issues.
• Team and Criteria: It stresses that MBS should be performed by fully trained teams, including surgeons, nurse specialists, dietitians, and psychologists, and establishes clear eligibility criteria and contraindications for surgery.
• Patient Preparation: The study highlights the importance of preoperative weight management and patient education, the need for informed consent, and lifelong follow-up, ensuring patients understand post-surgery expectations and lifestyle changes.