Background

In recent years, the number of guidelines published for provision of bariatric surgery and its related care has sharply increased. However, the quality of these guidelines remains unknown, leaving providers with some degree of uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for the perioperative bariatric surgery care.

Methods

A comprehensive search of MEDLINE and EMBASE were conducted from January 2010-October 2022 for bariatric clinical practice guidelines in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework.

Results

A total of 42 studies were included, with 25 guidelines, 10 position statements, and 7 consensus statements. Intra-class coefficient of each AGREEII domainscores were greater than 0.9, indicating high consistency among raters. The overall median (IQR) domain scores were: 1) scope and purpose: 86% (43%-99%), 2) stakeholder involvement: 44% (6%-99%), 3) rigor of development: 36% (11%-99%), 4) clarity of presentation: 83% (49%-100%), 5) applicability: 7% (0-77%), 6) editorial independence: 50% (0%-100%), 7) overall impressions: 42% (14%-96%). Of 25 guidelines, only five guidelines achieved an overall score >70%.

Conclusions

Current bariatric surgery guidelines effectively outlined their aim and clearly presented recommendations. However, many failed to seek patient input, adequately state search criteria, use standardized evidence rating tools, and consider resource implications. Future guidelines should focus on clearly stating its methodology and differentiating guidelines from position statements to allow for evidence-based bariatric care.