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Year : 2023  |  Volume : 2  |  Issue : 2  |  Page : 68-78

Patient pathways to bariatric surgery: What preoperative medical weight management programs exist globally – Results of an international survey

1 South East Scotland Bariatric Service, Royal Infirmary of Edinburgh; Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
2 Fife Adult Weight Management Service, Victoria Hospital, Kirkcaldy, United Kingdom
3 South East Scotland Bariatric Service, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
4 Division of Surgery, Imperial College London, St Marys Hospital, London, United Kingdom
5 Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
6 Department of General Surgery Royal Derby Hospital, Derby, United Kingdom
7 Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom

Correspondence Address:
Mr. Andrew G N. Robertson
Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Scotland
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jbs.jbs_3_23

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Introduction: Bariatric surgery is an accepted treatment worldwide for patients with obesity due to its proven metabolic effects. However, there are variations worldwide in clinical criteria that must be met to qualify for surgery. This study aims to explore globally established practice and opinions on preoperative workup for bariatric surgery. Materials and Methods: A review of literature and international guidelines was performed by a multidisciplinary team and used to develop an online questionnaire survey. This was distributed to bariatric professionals electronically. Results: Two hundred and forty-four bariatric health-care professionals from 224 medical centers across 57 countries completed the survey. The majority of respondents were surgeons (67.2%), and the remainder were other multidisciplinary professionals. Over half of medical centers were public hospitals (50.8%), with most performing over 200 procedures per year (30.3%). Only 68.4% (n = 167) of respondent hospitals used recognized referral guidelines; however, 81.9% felt that there should be written referral criteria (P < 0.001). In 71.3% (n = 172) of respondent units' patients underwent a Medical Weight Management Programme (MWMP) as part of their preparation for surgery. Significant differences were identified worldwide in the criteria used to determine progression to surgery (P < 0.001), time spent in MWMP prior to surgery (P < 0.001), and the roles of members forming the bariatric multidisciplinary team (P = 0.006). Conclusion: This study has identified significant variation in global bariatric surgery practices and highlights the responsibility that societies such as the International Federation for the Surgery of Obesity and Metabolic Disease (IFSO) and the Upper Gastrointestinal Surgery Society have in promoting universal clinical guidelines.

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