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    Rights statement: The final publication is available at Springer via http://dx.doi.org/10.1038/s41366-022-01119-x

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    Embargo ends: 11/10/22

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Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals

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  • Wah Yang
  • Sally Abbott
  • Cynthia-Michelle Borg
  • Paul Chesworth
  • Yitka Graham
  • Jennifer Logue
  • Jane Ogden
  • Mary O’Kane
  • Denise Ratcliffe
  • Shiri Sherf-Dagan
  • Rishi Singhal
  • Vanessa Snowdon-Carr
  • Abd Tahrani
  • Kamal Mahawar
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<mark>Journal publication date</mark>31/07/2022
<mark>Journal</mark>International Journal of Obesity
Volume46
Number of pages10
Pages (from-to)1341–1350
Publication StatusPublished
Early online date11/04/22
<mark>Original language</mark>English

Abstract

Background
Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS.

Methods
A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable.

Results
Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent.

Conclusions
This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.

Bibliographic note

The final publication is available at Springer via http://dx.doi.org/10.1038/s41366-022-01119-x