Wah Yang1,2,3, Sally Abbott4,5, Cynthia-Michelle Borg6, Paul Chesworth7, Yitka Graham8,9,10, Jennifer Logue11, Jane Ogden12, Mary O'Kane13, Denise Ratcliffe14, Shiri Sherf-Dagan15,16, Rishi Singhal17,18, Vanessa Snowdon-Carr19, Abd Tahrani20,21,22, Kamal Mahawar8,10. 1. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. yangwah@qq.com. 2. Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China. yangwah@qq.com. 3. Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China. yangwah@qq.com. 4. University Hospitals Coventry and Warwickshire, Coventry, UK. 5. Faculty of Health and Life Sciences, Coventry University, Coventry, UK. 6. University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK. 7. Patient Representative, Liverpool, UK. 8. Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK. 9. Faculdad de Psicologia, Universidad de Anahuac, Mexico City, Mexico. 10. Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK. 11. Lancaster Medical School, Lancaster University, Lancaster, UK. 12. School of Psychology, University of Surrey, Guildford, UK. 13. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 14. Phoenix Health, Chester, UK. 15. Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel. 16. Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel. 17. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 18. University of Birmingham, Birmingham, UK. 19. E-Weightloss Surgery Ltd, Bristol, UK. 20. Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. 21. Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 22. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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.
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.
Authors: Mary O'Kane; Helen M Parretti; Jonathan Pinkney; Richard Welbourn; Carly A Hughes; Jessica Mok; Nerissa Walker; Denise Thomas; Jennifer Devin; Karen D Coulman; Gail Pinnock; Rachel L Batterham; Kamal K Mahawar; Manisha Sharma; Alex I Blakemore; Iris McMillan; Julian H Barth Journal: Obes Rev Date: 2020-08-02 Impact factor: 9.213