Clyde Danielle R, Adib Reza, Baig Sarfaraz, Bhasker Aparna G, Byrne James, Cameron David, Catalain Copaescu, Clare Ken, de Beaux Andrew, Drummond Gillian, Fawal Hayssam, Fried Martin, Ghanem Omar, Graham Yitka, Goel Ramen, Hopkins George, Husain Farah, Joyce Brian, Kermansaravi Mohammad, Kothari Shanu, Kow Lilian, Leite Silvia, Madhok Brij, Mahon David, Miller Karl, Miras Alex, Moussa Osama, Neto Manoel G, Nimeri Abdelrahman, O'Kane Mary, Parmar Chetan, Peterli Ralph, Poggi Luis, Saliminen Paulina, Sarkar Rupa, Shenfine Jon, Sogg Stephanie, Stenberg Erik, Suter Michel, Taha Safwan, Tahrani Abd, Vilallonga Ramon, Voon Kelvin, Welbourn Richard, Zerrweck Carlos, Lamb Peter, Mahawar Kamal K, Yang Wah, Robertson Andrew G N
Royal Infirmary of Edinburgh, Edinburgh, UK.
Clinical Department of Surgery, University of Edinburgh, Edinburgh, UK.
Clin Obes. 2025 Apr;15(2):e12722. doi: 10.1111/cob.12722. Epub 2024 Dec 14.
Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m), 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.
全球肥胖率急剧上升，目前已超过饥饿致死率。代谢与减重手术（MBS）最初针对重度肥胖（体重指数≥35 kg/m²），全球每年实施超过50万例，除减重外还带来显著的代谢益处。然而，全球不同的资格标准影响患者护理和医疗资源。2022年更新的美国代谢与减重外科学会（ASMBS）和国际肥胖与代谢病外科联盟（IFSO）指南旨在规范MBS的适应症，反映当前的认识并强调全面的术前评估。然而，临床差异依然存在，因此需要基于共识的建议。这项改良的德尔菲研究邀请了45位全球专家就MBS围手术期管理达成共识。从减重外科协会挑选的专家在MBS方面具有专业知识，并参与了两轮德尔菲流程。在169条陈述中的90条（53.3%）上达成了共识，内容涵盖多学科团队组成、患者选择标准、术前检查和转诊途径。该共识凸显了全面术前评估以及医疗专业人员在MBS中的整合的关键作用。这些发现为规范围手术期实践并在全球倡导基于证据的MBS指南提供了重要见解。该研究强调了需要统一的方案以优化结果并指导MBS未来的研究。
