An international Delphi consensus on patient preparation for metabolic and bariatric surgery

Danielle R Clyde; Reza Adib; Sarfaraz Baig; Aparna G Bhasker; James Byrne; David Cameron; Copaescu Catalain; Ken Clare; Andrew de Beaux; Gillian Drummond; Hayssam Fawal; Martin Fried; Omar Ghanem; Yitka Graham; Ramen Goel; George Hopkins; Farah Husain; Brian Joyce; Mohammad Kermansaravi; Shanu Kothari; Lilian Kow; Silvia Leite; Brij Madhok; David Mahon; Karl Miller; Alex Miras; Osama Moussa; Manoel G Neto; Abdelrahman Nimeri; Mary O'Kane; Chetan Parmar; Ralph Peterli; Luis Poggi; Paulina Saliminen; Rupa Sarkar; Jon Shenfine; Stephanie Sogg; Erik Stenberg; Michel Suter; Safwan Taha; Abd Tahrani; Ramon Vilallonga; Kelvin Voon; Richard Welbourn; Carlos Zerrweck; Peter Lamb; Kamal K Mahawar; Wah Yang; Andrew G N Robertson

doi:10.1111/cob.12722

An international Delphi consensus on patient preparation for metabolic and bariatric surgery

Clin Obes. 2024 Dec 14:e12722. doi: 10.1111/cob.12722. Online ahead of print.

Authors

Danielle R Clyde^{1

2}, Reza Adib³, Sarfaraz Baig⁴, Aparna G Bhasker⁵, James Byrne⁶, David Cameron¹, Copaescu Catalain⁷, Ken Clare⁸, Andrew de Beaux¹, Gillian Drummond¹, Hayssam Fawal⁹, Martin Fried¹⁰, Omar Ghanem¹¹, Yitka Graham¹², Ramen Goel¹³, George Hopkins¹⁴, Farah Husain¹⁵, Brian Joyce¹, Mohammad Kermansaravi¹⁶, Shanu Kothari¹⁷, Lilian Kow¹⁸, Silvia Leite¹⁹, Brij Madhok²⁰, David Mahon²¹, Karl Miller²², Alex Miras²³, Osama Moussa²⁴, Manoel G Neto²⁵, Abdelrahman Nimeri²⁶, Mary O'Kane²⁷, Chetan Parmar^{28

29}, Ralph Peterli³⁰, Luis Poggi³¹, Paulina Saliminen³², Rupa Sarkar³³, Jon Shenfine³⁴, Stephanie Sogg^{35

36}, Erik Stenberg³⁷, Michel Suter^{38

39}, Safwan Taha⁴⁰, Abd Tahrani⁴¹, Ramon Vilallonga⁴², Kelvin Voon⁴³, Richard Welbourn²¹, Carlos Zerrweck⁴⁴, Peter Lamb^{1

2}, Kamal K Mahawar^{12

45}, Wah Yang⁴⁶, Andrew G N Robertson^{1

2}

Affiliations

¹ Royal Infirmary of Edinburgh, Edinburgh, UK.
² Clinical Department of Surgery, University of Edinburgh, Edinburgh, UK.
³ Wesley Hospital, Brisbane, Australia.
⁴ Digestive Surgery Clinic, Kolkata, India.
⁵ MetaHeal, Laparoscopy and Bariatric Surgery Center, Mumbai, India.
⁶ Southampton General Hospital, Southampton, UK.
⁷ Ponderas Academic Hospital, Bucharest, Romania.
⁸ Leeds Beckett University, Leeds, UK.
⁹ Makassed General Hospital, Beirut, Lebanon.
¹⁰ OB Klinika, Prague, Czech Republic.
¹¹ Mayo Clinic, Rochester, Minnesota, USA.
¹² University of Sunderland, Sunderland, UK.
¹³ Wockhardt Hospital, Mumbai, India.
¹⁴ Royal Brisbane & Women's Hospital, Brisbane, Australia.
¹⁵ University of Arizona College of Medicine Phoenix, USA.
¹⁶ Hazrat-e Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
¹⁷ Prisma Health, Greenville, USA.
¹⁸ Flinders Medical Centre, Adelaide, Australia.
¹⁹ University of Brasilia-DF, Brazil.
²⁰ University Hospitals of Derby and Burton NHS Foundation Trust.
²¹ Somerset NHS Foundation Trust, Somerset, UK.
²² University of Innsbruck, Austria.
²³ Imperial College London, London, UK.
²⁴ West Hertfordshire Teaching Hospitals NHS Trust, UK.
²⁵ Orlando Health Weight Loss and Bariatric Surgery Institute, Florida, USA.
²⁶ Brigham and Women's Hospital, Boston, USA.
²⁷ Leeds Teaching Hospitals NHS Trust, Leeds, UK.
²⁸ Whittington Hospital, London, UK.
²⁹ University College London, London, UK.
³⁰ St. Clara and University Hospital, Basel, Switzerland.
³¹ Clínica Anglo American, Lima, Peru.
³² University of Turku, Turku University Hospital, Turku, Finland.
³³ Mid Yorkshire Teaching Trust, UK.
³⁴ Jersey General Hospital, Jersey.
³⁵ Massachusetts General Hospital Weight Center, Boston, USA.
³⁶ Harvard Medical School, Boston, USA.
³⁷ Örebro University, Örebro, Sweden.
³⁸ Riviera-Chablais Hospital, Rennaz, Switzerland.
³⁹ Faculty of Biology and Medicine, University of Lausanne, Switzerland.
⁴⁰ Mediclinic Airport Road Hospital, Abu Dhabi, UAE.
⁴¹ University of Birmingham, Birmingham, UK.
⁴² Hospital Vall de Hebron, Barcelona, Spain.
⁴³ Sunway Medical Centre, Penang, Malaysia.
⁴⁴ ABC Medical Center, Mexico City, Mexico.
⁴⁵ South Tyneside and Sunderland NHS Health Trust, UK.
⁴⁶ Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.

PMID: 39673462
DOI: 10.1111/cob.12722

Abstract

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. 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. 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. 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.

Keywords: Delphi; metabolic and bariatric surgery; perioperative.