Impact of preoperative weight loss on 30-day complication rate after bariatric surgery
Abstract
BACKGROUND: The aim of this study is to evaluate the impact of preoperative weight loss on surgical outcomes and operating room (OR) times after primary bariatric procedures, including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (RYGB). STUDY DESIGN: A retrospective cohort study uses the 2021 MBSAQIP dataset. Preoperative total weight loss (TWL)% was calculated. Patients were then divided in to 4 groups: those with no weight loss, lost <0 to <5%, lost ≥5% to <10%, or lost ≥10% TWL preoperatively. These groups were then stratified into those with BMI less than 50 kg/m 2 and those with BMI 50 kg/m 2 or more and 30-day outcomes and OR times were compared. RESULTS: Analysis included 171,010 patients. For BMI less than 50 kg/m 2 , preoperative weight loss led to no consistent improvement in surgical outcomes. Although >0% to <5% TWL led to a decrease in intra- and postoperative occurrences after RYGB and a decrease in reoperation rates after LSG, these observations were not seen in those with higher degree of weight loss. In patients with BMI 50 kg/m 2 or more, preoperative weight loss showed a consistent improvement in reintervention rates after LSG, and readmission rates after RYGB. There was no improvement in other outcomes, however, irrespective of degree of preoperative weight loss. CONCLUSIONS: In patients undergoing primary bariatric surgery, preoperative weight loss does not lead to a consistent improvement in outcomes or OR times. In those with BMI 50 kg/m 2 or more, there may be improvement in select outcomes that is procedure-specific. Overall, these data do not support a uniform policy of preoperative weight loss, although selective use in some high-risk patients may be appropriate.
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Evidence from bariatric surgery cohorts suggests that weight loss before surgery is linked to better long-term outcomes, including lower postoperative complication rates, improved weight maintenance, and enhanced metabolic control.
“Further, evidence from bariatric surgery cohorts suggests that weight loss before surgery is linked to better long-term outcomes, including lower postoperative complication rates, improved weight maintenance, and enhanced metabolic control.53,54”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [54]
Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61602-x · Cited by 21,320 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010 · Cited by 17,796 · see citing works
Eisenberg, D., Shikora, S. A., Aarts, E., Aminian, A., Angrisani, L., Cohen, R. V., De Luca, M., Faria, S. L., Goodpaster, K. P. S., Haddad, A., et al. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.08.013 · Cited by 985 · see citing works
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2019) · Endocrine Practice · doi:10.4158/gl-2019-0406 · Cited by 510 · see citing works
ASMBS updated position statement on insurance mandated preoperative weight loss requirements
Kim, J. J., Rogers, A. M., Ballem, N., & Schirmer, B. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.04.019 · Cited by 133 · see citing works
Association of Preoperative Body Weight and Weight Loss With Risk of Death After Bariatric Surgery
Sun, Y., Liu, B., Smith, J. K., Correia, M., Jones, D. L., Zhu, Z., Taiwo, A., Morselli, L. L., Robinson, K. N., Hart, A. A., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.4803 · Cited by 104 · see citing works
The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings
Tucker, S., Bramante, C. T., Conroy, M. B., Fitch, A., Gilden, A. H., Wittleder, S., & Jay, M. R. (2021) · Current Obesity Reports · doi:10.1007/s13679-021-00444-y · Cited by 73 · see citing works
Romeijn, M. M., Kolen, A. M., Holthuijsen, D. D. B., Janssen, L., Schep, G., Leclercq, W. K. G., & van Dielen, F. M. H. (2020) · Obesity Surgery · doi:10.1007/s11695-020-05070-6 · Cited by 56 · see citing works
Roman, M., Monaghan, A., Serraino, G. F., Miller, D., Pathak, S., Lai, F., Zaccardi, F., Ghanchi, A., Khunti, K. K., Davies, M. J., et al. (2018) · British journal of surgery · doi:10.1002/bjs.11001 · Cited by 53 · see citing works
Telem, D. A., & Dimick, J. B. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2018.0495 · Cited by 36 · see citing works
Ying, L., Chao, G. F., Canner, J. K., Graetz, E., Ghiassi, S., Schwartz, J. S., Zolfaghari, E. J., Schneider, E. B., & Gibbs, K. E. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06944-1 · Cited by 14 · see citing works
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Kamarajah, S. K., Gudiozzi, N., Findlay, J. M., Lee, M. J., Pinkney, T., & Markar, S. R. (2025) · eClinicalMedicine · doi:10.1016/j.eclinm.2025.103408 · Cited by 29 · see citing works
The effect of preoperative body weight loss on 5-year bariatric surgery outcomes
Flores, L., Andreu, A., Olbeyra, R. P., Cañizares, S., Claro, M., Ríos, J., Molero, J., Jiménez, A., & Vidal, J. (2025) · International Journal of Obesity · doi:10.1038/s41366-025-01794-6 · Cited by 2 · see citing works
Mushtaq, M. N., Hamid, M., Rahman, A., Javed, F., Issa, M. T., Naqvi, M., Kabir, S. A., Mirza, S., Khan, A. U., & Karim, M. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08525-4 · Cited by 1 · see citing works
Hess, D. T. (2024) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000001075
Jain, V., McMullen, C. A., Kimbrough, J., Rockich, A. K., Davenport, D. L., Hawk, G. S., Nikolajczyk, B. S., Kern, P. A., Fisher, S. J., Steiner, J. P., et al. (2026) · Journal of Surgical Research · doi:10.1016/j.jss.2026.01.004
Monshizadeh, A., Rezvani, M., Talebpour, M., Nourzad, S. H. H., & Latif, A. (2026) · Research Square · doi:10.21203/rs.3.rs-8863406/v1
Ko, C. S. (2026) · Journal of Metabolic and Bariatric Surgery · doi:10.17476/jmbs.2026.15.1.28
Preoperative Weight Loss: Helpful, Harmful or Irrelevant?
Hanipah, Z. N., & Schauer, P. R. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08763-6
- Authors
- Saleh, O. S., Farag, Y. M. K., Medhati, P., & Tavakkoli, A.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Tavakkoli, Ali
- Venue
- Journal of the American College of Surgeons
- Published
- 2024-02-12
- Volume
- 238
- Issue
- 6
- Pages
- 993-999
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W4391746163
- Cited by
- 8
- References
- 11
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 1
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- preoperative weight loss, bariatric surgery, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, 30-day postoperative complications, operating room time, reoperation, hospital readmission, morbid obesity, extremely obese patients, MBSAQIP
- MeSH terms
- Adult, Female, Gastrectomy, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Postoperative Complications, Reoperation, Retrospective Studies, Gastric Bypass, Weight Loss, Body Mass Index, Treatment Outcome, Bariatric Surgery, Preoperative Period
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