Preoperative body mass index reduction and 30-day outcomes after metabolic and bariatric surgery: an MBSAQIP 2015-2023 analysis

Document Type

Article

Publication Date

4-22-2026

Publication Title

Surgery for Obesity and Related Diseases

Abstract

BACKGROUND: Preoperative weight loss is often recommended before metabolic and bariatric surgery, although its impact on postoperative outcomes, particularly in high body mass index (BMI) patients (e.g., 50.0-59.9, ≥60), is not fully established. OBJECTIVE: To test the hypothesis that preoperative body mass index reduction (PBR) is associated with improved postoperative outcomes. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, 2015-2023. METHODS: A total of 1,795,127 records were examined, and primary cases were selected while excluding emergencies, revisions, conversions, cases with incomplete data, and preoperative BMI < 30 kg/m. PBR was expressed as a percentage of the highest preoperative BMI. No BMI loss, < 10% loss, and ≥10% loss categories were arbitrarily analyzed. Regression analysis was used to analyze outcomes, including prolonged length of stay (>5 days), serious complications, and readmissions. RESULTS: Among 1,316,050 cases, close to 83% achieved PBR and 6.5% achieved ≥10% PBR. Across all starting BMI, PBR was associated with a lower risk of prolonged length of stay (>5 days). Additionally, for BMI ≥60, there was a significant reduction in serious complications with < 10% PBR. Similar trends persisted for >10% PBR for serious complications and readmissions. CONCLUSIONS: PBR has selective benefits for high-BMI metabolic and bariatric surgery patients. Although complications overall are uncommon, PBR's effect on the risk of these outcomes varies. Focused studies examining well-controlled groups are needed to better understand the potential differences in PBR across the BMI spectrum.

PubMed ID

42135179

Rights

© 2026 American Society for Metabolic and Bariatric Surgery.

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