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Pre-surgical weight loss

Weight loss prior to surgery may not be safe for all patients

Pre-operative percent weight loss was associated with increased incidence of superficial surgical site infections and urinary tract infections

Weight loss prior to metabolic and bariatric surgery may not be necessary for all patients and unsafe weight loss prior to surgery may compromise nutrition status and lead to increased infection rates, according to researchers from the University of Pennsylvania.

The study, ’ Weight Loss Prior to Bariatric Surgery and 30-Day Mortality, Readmission, Reoperation, and Intervention: an MBSAQIP Analysis of 349,016 Cases’, published in Obesity Surgery, sought to assess whether preoperative weight loss is associated with 30-day postoperative quality outcomes in adults undergoing metabolic and bariatric surgery. Bariatric surgery patients have traditionally followed a medically supervised weight-loss programme prior to surgery, primarily as patients were encouraged to lose weight via non-surgical treatments (diet, exercise, weight loss drugs etc).

This retrospective cohort study assessed adults who underwent Roux-en-Y gastric bypass or sleeve gastrectomy in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) from 2015 to 2017. The relationship between preoperative weight loss and 30-day readmission, reoperation, mortality, intervention, and morbidity was assessed using multivariable logistic regression.

The study included some 349,000 patients and reported that pre-operative weight loss, body mass index loss and percent weight loss were not associated with 30-day postoperative overall readmission, reoperation, mortality or intervention (p > 0.01). However, pre-operative percent weight loss was associated with increased incidence of superficial surgical site infections (p=0.001) and urinary tract infections (p<0.001).

The requirement to enter such pre-surgical weight loss programmes can be a requirement of insurance carriers who require weight loss and counselling before surgical treatment. In June 2016, in a position statement published in SOARD, ‘ASMBS updated position statement on insurance mandated preoperative weight loss requirements’, the American Society for Metabolic and Bariatric Surgery stated that it disagreed with the requirement, adding that mandating preoperative weight loss "contributes to patient attrition, causes unnecessary delay of lifesaving treatment, leads to the progression of life-threatening co-morbid conditions, is unethical, and should be abandoned."

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