The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

Abstract

Background: Performing bariatric surgery on patients with a body mass index (BMI) of over 50 kg/m2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. Materials and Methods: A prospective survey was designed to investigate the perioperative management of patients with a BMI of ≥50 kg/m2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anesthesia, and postoperative management measures. A response from only one attending physician per bariatric center was accepted. Results: Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centers had completed a total of 44,702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3,280 patients had a BMI exceeding 50 kg/m2. The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centers, Roux-en-Y gastric bypass by 11 centers, sleeve gastrectomy plus jejunojejunal bypass by 19 centers, one anastomosis gastric bypass by 1 center, and duodenal switch by 1 center. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centers believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only 3 centers considered using intragastric balloon placement. Postoperative management measures varied greatly. Conclusion: Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m2. The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.