McKechnie Tyler, Thabane Alex, Staibano Phillip, Saddik Maisa, Kuszaj Olivia, Guez Manon, Hong Dennis, Doumouras Aristithes, Eskicioglu Cagla, Parpia Sameer, Bhandari Mohit
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Front Surg. 2025 Mar 28;12:1529116. doi: 10.3389/fsurg.2025.1529116. eCollection 2025.
The surgical patient with obesity presents several challenges in intraoperative and postoperative care. We designed this cross-sectional survey to assess surgeon willingness to prescribe preoperative very low energy diets (VLEDs) and practice patterns in prescribing preoperative weight loss interventions for patients with obesity undergoing non-bariatric abdominal surgery.
We conducted a cross-sectional survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery, reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies and utilizing non-probability convenience sampling. The primary outcome was willingness to prescribe preoperative VLED to obese patients undergoing major non-bariatric abdominal surgery for both benign and malignant indications. We created a multivariable proportional odds model to identify factors associated with willingness to prescribe VLEDs. A total of 78 participants completed and returned the survey (response rate 10.9%; mean age 43.54 ± 8.13 years; 48.72% female). Most surgeons (79.5%) felt that obesity significantly impacted the technical difficulty of their operations. We identified a disconnect between those surgeons who were willing prescribe VLEDs vs. those who actually prescribed them (78.2% vs. 30.8%, respectively). Approximately half of the surgeons reported being unfamiliar with VLEDs. Regression analysis identified practicing in academic institutions was associated with increased willingness to prescribe [odds ratio (OR) 3.71, 95% confidence intervals (CI) 1.01-13.7, < 0.01].
Although the majority of surgeons feel that obesity adversely impacts perioperative care, only one-third routinely discuss preoperative VLEDs with their patients. Opportunities to increase awareness and evaluate the impact of VLEDs on patient outcomes remain high.
肥胖的外科手术患者在术中和术后护理方面面临诸多挑战。我们设计了这项横断面调查，以评估外科医生为接受非减重腹部手术的肥胖患者开具术前极低能量饮食（VLED）的意愿以及开具术前减重干预措施的实践模式。
我们对在加拿大进行主要非减重腹部手术的执业外科医生进行了横断面调查，调查按照基于共识的调查研究报告清单进行，并采用非概率便利抽样。主要结果是为患有良性和恶性疾病且接受主要非减重腹部手术的肥胖患者开具术前VLED的意愿。我们创建了一个多变量比例优势模型，以确定与开具VLED意愿相关的因素。共有78名参与者完成并返回了调查问卷（回复率10.9%；平均年龄43.54±8.13岁；女性占48.72%）。大多数外科医生（79.5%）认为肥胖会显著影响其手术的技术难度。我们发现愿意开具VLED的外科医生与实际开具VLED的外科医生之间存在脱节（分别为78.2%和30.8%）。大约一半的外科医生表示不熟悉VLED。回归分析表明，在学术机构执业与开具意愿增加相关[优势比（OR）3.71，95%置信区间（CI）1.01 - 13.7，P < 0.01]。
尽管大多数外科医生认为肥胖会对围手术期护理产生不利影响，但只有三分之一的医生会常规地与患者讨论术前VLED。提高对VLED的认识并评估其对患者预后影响的机会仍然很大。
