# Prescribing preoperative weight loss prior to major non-bariatric surgery for patients with elevated weight: a national provider survey (PREPARE provider survey)

## TL;DR

This study explores how willing and how often surgeons prescribe preoperative weight loss diets to obese patients before non-bariatric surgery.

## Contribution

The study reveals a gap between surgeon willingness and actual prescription of preoperative very low energy diets.

## Key findings

- Most surgeons believe obesity increases surgical difficulty, but only 30.8% actually prescribe VLEDs.
- Academic surgeons are more willing to prescribe VLEDs compared to others.
- Approximately half of the surveyed surgeons are unfamiliar with VLEDs.

## Abstract

The surgical patient with obesity presents several challenges in intraoperative and postoperative care. We designed this cross-sectional survey to assess surgeon willingness to prescribe preoperative very low energy diets (VLEDs) and practice patterns in prescribing preoperative weight loss interventions for patients with obesity undergoing non-bariatric abdominal surgery.

We conducted a cross-sectional survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery, reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies and utilizing non-probability convenience sampling. The primary outcome was willingness to prescribe preoperative VLED to obese patients undergoing major non-bariatric abdominal surgery for both benign and malignant indications. We created a multivariable proportional odds model to identify factors associated with willingness to prescribe VLEDs. A total of 78 participants completed and returned the survey (response rate 10.9%; mean age 43.54 ± 8.13 years; 48.72% female). Most surgeons (79.5%) felt that obesity significantly impacted the technical difficulty of their operations. We identified a disconnect between those surgeons who were willing prescribe VLEDs vs. those who actually prescribed them (78.2% vs. 30.8%, respectively). Approximately half of the surgeons reported being unfamiliar with VLEDs. Regression analysis identified practicing in academic institutions was associated with increased willingness to prescribe [odds ratio (OR) 3.71, 95% confidence intervals (CI) 1.01–13.7, p < 0.01].

Although the majority of surgeons feel that obesity adversely impacts perioperative care, only one-third routinely discuss preoperative VLEDs with their patients. Opportunities to increase awareness and evaluate the impact of VLEDs on patient outcomes remain high.