The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study.

Abstract

Performing bariatric surgery on patients with a BMI of over 50kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.