Background

Bariatric surgery patients often undergo preoperative multidisciplinary evaluation to identify those at elevated risk and guide preoperative optimization. This study evaluates implementation of a multidisciplinary preoperative complexity scoring system across three major clinical domains of bariatric surgery: surgical, nutritional, and psychological, and investigates the relationship between complexity score and postsurgical outcomes.

Methods

Since July 2021, bariatric surgery patients at a single center of excellence received a preoperative complexity score ranging from 1 (least complex) to 3 (highly complex) in surgical, nutritional, and psychological domains. A single domain score of 3 or a combined score of 6 or higher defined a complex patient. All complex patients were discussed at our multidisciplinary team meeting.

Results

In total, 112 patients met inclusion criteria with an 83.9% female predominance. Complexity scores across the psychological domain were 1(n=78), 2(n=31), and 3(n=3). Nutritional domain scores were 1(n=103), 2(n=8), and 3(n=1). Surgical domain scores were 1(n=85), 2(n=19), and 3(n=8). This yielded an overall complex patient pool of 8.9%(n=10) and an overall non-complex patient pool of 91.1%(n=102). There were no 30-day mortalities. Primary endpoint analysis demonstrated no statistical difference in mean percent excess body weight loss at 1 year (63.1% vs 69.4%, p=0.91), 30-day emergency observations (10.0% vs 8.8%, p=0.68), 30-day readmissions (10.0% vs 5.8%, p=0.08), or postoperative appointment attendance (3.5 vs 3.9 appointments, p=0.40).

Conclusions

Implementation of a multidisciplinary patient complexity scoring system has exemplified that surgically, nutritionally, and psychologically complex patients can achieve similar perioperative safety and postoperative weight loss as less-complex patients.