Table 7.

Module 4—Patient preparation for metabolic and bariatric surgery (N = 94 voters in round 1; 79 in round 2)

Statements (N = 23)	N*	Rounds required	Most common selection	Percentage consensus
General health (N = 10)
A comprehensive medical and nutritional evaluation should be completed before bariatric surgery	93	1	Agree	100.0%
Nutrient deficiencies should be evaluated and corrected in all candidates for bariatric surgery	93	1	Agree	98.9%
Among smokers, smoking cessation is recommended before bariatric surgery	93	1	Agree	96.8%
Sleep apnea screening is recommended, with testing only necessary in patients in whom there is a high suspicion of sleep apnea	92	1	Agree	89.1%
Weight reduction decreases a person’s future risk of developing cholangiocarcinoma	79	2	Not yet known	86.1%
Computed tomography or magnetic resonance imaging should be used routinely to screen for hepatocellular carcinoma in patients with metabolic-associated fatty liver disease	76	2	Disagree	81.6%
All antidiabetic drugs have an impact in reducing the risk of hepatocellular carcinoma in patients with metabolic-associated fatty liver disease	81	1	Disagree	80.2%
Pre-operative endoscopy should be performed in every patient undergoing bariatric surgery	88	1	Agree	76.5%
Screening for hepatocellular carcinoma should be performed in all patients with metabolic-associated fatty liver disease	76	2	Agree	71.1%
There are differences between the different modes of weight reduction (calorie restriction, exercise, drugs, endoscopic and bariatric surgery) in terms of reducing the risk of hepatocellular carcinoma	77	2	Agree	66.2%
COVID-19 (N = 13)
Due to the increased risk of severe symptoms from COVID in patients with obesity, until the spread of COVID-19 is well controlled, bariatric surgery procedures should be reduced to a minimum to reduce the risk of viral exposure	79	2	Disagree	94.9%
Considering that patients with obesity are at higher risk of a severe COVID-19 course, more restrictive measures should generally be undertaken during hospitalization for bariatric procedures or related pre-operative evaluations	78	2	Agree	93.6%
Especially during the pandemic, metabolically sicker patients with obesity should be prioritized for bariatric surgery, since they are at greater risk from the pandemic and treatment decreases their risk	79	2	Agree	91.1%
Unvaccinated, metabolically-sicker patients with obesity should be prioritized for vaccination against COVID-19	89	1	Agree	87.6%
Unvaccinated or incompletely vaccinated patients scheduled for bariatric surgery who test negative for COVID-19 at admission can be placed in double rooms with other patients who have tested negative	79	2	Agree	83.5%
Since diabetes mellitus places patients at increased risk of a severe COVID-19 course, patients with diabetes or who are otherwise metabolically compromised warrant special protective measures during their care	78	2	Agree	83.3%
Outpatients undergoing pre-operative evaluations should have an antigenic COVID swab test on the day of the planned procedure or investigation	79	2	Agree	82.3%
Before gaining any kind of access to the hospital, all patients with obesity should be contacted by telephone and asked to report any recent potential COVID exposure or symptoms, as well as any situations or behaviors that might have placed them at particular risk of becoming infected	92	1	Agree	81.5%
Since vitamin D is thought to be a protective factor, measurement of and/or treatment with vitamin D should be considered prior to treating patients with obesity	90	1	Agree	80.0%
Since elevated interleukin-6 is considered a risk factor for a more severe COVID-19 course and is disproportionately elevated in patients with obesity, the level of IL-6 should be measured in all patients being treated for obesity, either before or at the beginning of their treatment	85	1	Disagree	76.5%
More stringent anticoagulation after surgery/endoscopy should be considered for patients undergoing MBS because of the increased risk of thrombosis due to obesity per se and COVID	76	2	Agree	76.3%
Patients scheduled for bariatric surgery who require hospitalization should have a PCR swab 24 h before hospital admission and, if their hospitalization is longer than 48 h, should have a second PSR swab at the time of hospital discharge	79	2	Agree	74.7%
Due to the increased risk of a severe COVID-19 course in patients with obesity, during the COVID-19 pandemic, patients undergoing bariatric surgery should be provided a single room, both pre- and post-operatively, throughout their hospitalization for surgery	78	2	Agree	70.5%

Italicized statements did not reach consensus

MBS metabolic and bariatric surgery, COVID coronavirus disease, PCR polymerase chain reaction test

*N = number of voters in the final/definitive round of voting on the statement,