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Bariatric Surgery

Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II)

International Journal of Obesity volume 48, pages 1193–1204 (2024)Cite this article

Subjects

Abstract

Background

In recent years, multiple guidelines on bariatric and metabolic surgery were published, however, their quality remains unknown, leaving providers with uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for perioperative bariatric surgery care.

Methods

A comprehensive search of MEDLINE and EMBASE were conducted from January 2010 to October 2022 for bariatric clinical practice guidelines. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework.

Results

The initial search yielded 1483 citations, of which, 26 were included in final analysis. The overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (IQR: 57–94%), (2) stakeholder involvement: 49% (IQR: 40–64%), (3) rigor of development: 42.5% (IQR: 22–68%), (4) clarity of presentation: 85% (IQR: 81–90%), (5) applicability: 6% (IQR: 3–16%), (6) editorial independence: 50% (IQR: 48–67%), (7) overall impressions: 48% (IQR: 33–67%). Only six guidelines achieved an overall score >70%.

Conclusions

Bariatric surgery guidelines effectively outlined their aim and presented recommendations. However, many did not adequately seek patient input, state search criteria, use evidence rating tools, and consider resource implications. Future guidelines should reference the AGREE II framework in study design.

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Data availability

All data is available in the supplemental spreadsheet containing raw data for the rating of guidelines.

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Acknowledgements

This project was submitted to the 2023 ASMBS Annual Meeting in Las Vegas, Nevada, U.S. and has been submitted for the application of the ASMBS John Halverson Young Investigator Award.

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Authors and Affiliations

  1. Division of General Surgery, McMaster University, Hamilton, ON, Canada

    Yung Lee, Caroline Hircock, Jigish Khamar, Umair Tahir, Yasith Samarasinghe, Tyler McKechnie, Aristithes Doumouras & Dennis Hong

  2. Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Jerry Dang & Matthew Kroh

  3. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    James Jung, Timothy Jackson & Allan Okrainec

  4. Department of Surgery, Queen’s University, Kingston, ON, Canada

    Boris Zevin

  5. Division of General Surgery, Western University, London, ON, Canada

    Ahmad Elnahas

  6. Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada

    Ashley Vergis & Krista Hardy

  7. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Richdeep Gill & Shahzeer Karmali

  8. Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada

    Jeffrey Gu

  9. Division of General Surgery, University of Montreal, Montreal, QC, Canada

    Radu Pescarus

  10. Department of Surgery, Laval University, Quebec City, QC, Canada

    Laurent Biertho

  11. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Elaine Lam

  12. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Amy Neville

  13. Division of General and Gastrointestinal Surgery, Dalhousie University, Halifax, NS, Canada

    James Ellsmere

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  1. Yung Lee
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Contributions

YL and DH conceptualized and designed the study, collected the data, interpreted and analyzed the data, provided contributions and critically revised the manuscript, and gave final approval of the version to be published. CH, JK, UT, YS collected the data, interpreted and analyzed the data, co-drafted the manuscript, and gave final approval of the version to be published. JD, JJ, BZ, AE, AV, KH, RG, JG, TM, RP, LB, EL, AN, JE, SK, TJ, AO, AD, MK, interpreted and analyzed the data, provided critical revisions to the manuscript and gave final approval of the version to be published.

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Correspondence to Dennis Hong.

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Lee, Y., Hircock, C., Dang, J. et al. Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II). Int J Obes 48, 1193–1204 (2024). https://doi.org/10.1038/s41366-024-01559-7

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