Abstract
Background
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.
Objective
To assess patient perspectives on the bariatric surgical calculator.
Setting
A randomized controlled trial at an MBSAQIP-accredited center.
Methods
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.
Results
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%).
Conclusions
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.
Keywords
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References
- U.S. Department of Health & Human Services, Washington, DC2022 ([updated 17 May 2022; cited 2022 Aug 6]. Adult obesity facts; [about 3 screens]. Available from:)
- American Society for Metabolic and Bariatric Surgery (ASMBS) [Internet]. ASMBS, Newberry, FL2022 ([2022 Jun; cited 2022 Aug 6]. Estimate of bariatric surgery numbers, 2011–2019; [about 2 screens]. Available from:)
- Effects of bariatric surgery on mortality in Swedish obese subjects.N Engl J Med. 2007; 357: 741-752
- Long-term mortality after gastric bypass surgery.N Engl J Med. 2007; 357: 753-761
- Surgery for weight loss in adults.Cochrane Database Syst Rev. 2014; 8: CD003641
- How and why do we measure surgical risk?.J R Soc Med. 2007; 100: 508-512
- Informed consent: an ethical obligation or legal compulsion?.J Cutan Aesthet Surg. 2008; 1: 33-35
- Communicating risk to patients and the public.Br J Gen Pract. 2012; 62: 213-216
- Development and validation of a bariatric surgery mortality risk calculator.J Am Coll Surg. 2012; 214: 892-900
- Development of a sleeve gastrectomy risk calculator.Surg Obes Relat Dis. 2015; 11: 758-764
- American Society for Metabolic and Bariatric Surgery (ASMBS) [Internet]. ASMBS, Newberry, FL2022 ([2019; cited 2022 Aug 6]. Bariatric Surgical Risk/Benefit Calculator; [about 1 screen]. Available from:)
- Band versus bypass: influence of an educational seminar and surgeon visit on patient preference.Surg Obes Relat Dis. 2007; 3: 452-455
- Correlating actual one-year weight loss with predicted weight loss by the MBSAQIP Bariatric Surgical Risk/Benefit Calculator.Surg Endosc. 2021; 35: 5705-5708
- The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Bariatric Surgical Risk/Benefit Calculator: 30-day risk.Surg Obes Relat Dis. 2021; 17: 1117-1124
- Understanding disposition after referral for bariatric surgery: when and why patients referred do not undergo surgery.Obes Surg. 2014; 24: 134-140
- Attrition after acceptance onto a publicly funded bariatric surgery program.Obes Surg. 2018; 28: 2500-2507
- Quality of life after bariatric surgery.Curr Obes Rep. 2017; 6: 204-210
- Benefits and risks of bariatric surgery in adults: a review.JAMA. 2020; 324: 879-887
- Patients’ preferences for information in bariatric surgery.Surg Obes Relat Dis. 2018; 14: 665-673
- Sleeve gastrectomy or gastric bypass: a “post-code” lottery? A comprehensive national analysis of the utilization of bariatric surgery in Switzerland between 2011 and 2017.Surg Obes Relat Dis. 2021; 17: 563-574
- Surgeon factors are strongly correlated with who receives a sleeve gastrectomy versus a Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2019; 15: 856-863
- Online survey on factors influencing patients’ motivation to undergo bariatric surgery.Clin Obes. 2022; 12e12500
- Patient preferences and bariatric surgery procedure selection; the need for shared decision-making.Obes Surg. 2014; 24: 1933-1939
Article info
Publication history
Published online: December 11, 2022
Accepted:
December 2,
2022
Received:
August 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Comment on: Patient Perspectives on the Usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: A Randomized Controlled TrialSurgery for Obesity and Related Diseases
- PreviewUntil 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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