Patient perspectives on the usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: a randomized controlled trial

Published:December 11, 2022DOI:



      The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator uses procedure-specific prediction models to generate individualized surgical risk/outcome estimates. This tool helps guide informed consent and operative selection. We hypothesized that calculator use would influence patient procedure choice.


      To assess patient perspectives on the bariatric surgical calculator.


      A randomized controlled trial at an MBSAQIP-accredited center.


      During the preoperative bariatric surgical office consultation, patients were randomized into 2 groups: the control group received conventional surgeon-led counseling, whereas surgeons used the risk/benefit calculator to guide decision making for the calculator group. Surveys were completed by patients following consultations to evaluate satisfaction and perceived impact of the risk/benefit calculator on operative selection.


      Between 2020 and 2022, 61 patients were randomized to the calculator group and 68 patients to the control group. The percentage of patients whose procedure of choice changed following consultation was similar in the calculator versus control group (44.3% versus 41.2%; P = .723). However, calculator group patients were less likely to perceive surgeon counseling as very important for their decision making (43.3% versus 76.5%; P < .001). Eighty-five percent of calculator group patients rated the calculator as useful or very useful, and only 1.7% found it not very important. The reasons patients changed procedure choice were similar between the groups (P = .091); the most common cause was to improve their anticipated outcome (48.7% versus 54.8%).


      While the risk/benefit calculator was perceived as a helpful tool by most patients, its use did not influence their procedure choice. However, the patient-reported usefulness and importance of the calculator during surgeon counseling suggest that the information provided has weight in patient decision making.


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      • Comment on: Patient Perspectives on the Usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: A Randomized Controlled Trial
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          Until the mid-20th century, there was no strict moral or legal obligation to involve patients in medical decision-making. The Hippocratic Corpus even guides physicians to conceal information from the patient; the physician knows best and has the duty to direct medical care1. After landmark court cases in the 1950s through 1970s, the doctrine of informed consent established the legal obligation for physicians to obtain consent before performing surgery2. Beyond the legal obligation, however, these decisions marked a shift away from paternalistic medicine towards shared decision-making, where physicians work in partnership with patients to align evidence-based medicine with patients’ individual belief systems and goals3.
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