Do intensive preoperative and postoperative multidisciplinary interventions impact health-related bariatric surgery outcomes? A systematic review

Background: Although pre- and postoperative support by a multidisciplinary team (MDT) is recommended as best practice, the impact of how this MDT intervention is delivered has not been reviewed.
Objectives: To evaluate the effect of intensive versus standard pre- and postoperative MDT interventions on health-related outcomes post-surgery in adult bariatric surgery patients.
Methods: Six databases were searched for intervention studies in any language up until July 2018. Study quality was assessed using the Cochrane Risk of Bias tool.
Results: 6,871 records were screened, identifying 25 eligible publications (n=15 trials; n=1,400 participants in total) which mostly had low to unclear risk of bias. Intensive interventions improved upon standard MDT interventions by providing: lifestyle counselling (n=4 trials), physical activity (n=8 trials), or psychological therapy (n=3 trial); which were delivered as preoperative (n=3 trials), postoperative (n=7 trials), or pre- and postoperative interventions (n=5 trials). No trial which concluded intervention delivery before 6-months post-surgery reported any effect compared with control (n=9 trials). All six trials which commenced or continued intensive MDT intervention past 6-months post-surgery reported significant improvements in weight and or fat loss (n=5 trials), insulin resistance (n=1 trial), depression (n=1 trial), or blood pressure (n=1 trial) compared with control.
Conclusion: This review suggests that to improve weight loss and health following barbaric surgery, intensive multidisciplinary interventions should commence at, or continue past, 6-months post-surgery, in addition to standard pre- and post-operative care.