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

Abstract

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.