Key result
Dietitian-led preoperative very low calorie diet linked to ~19% lower estimated risk of serious postoperative complications.
Why the study?
Adults with obesity are commonly asked to lose weight before elective surgery despite lacking evidence that intentional weight loss reduces postoperative complications.
Does a dietitian-led preoperative very low calorie diet reduce perioperative risk scores in patients with obesity awaiting elective non-bariatric surgery?
Cohort (n=141)
Does a dietitian-led preoperative very low calorie diet reduce perioperative risk scores in patients with obesity awaiting elective non-bariatric surgery?
p-value: p=<.001
A preoperative very low calorie diet led by a dietitian significantly reduced estimated perioperative risk scores and resulted in clinically significant weight loss in patients with obesity awaiting elective surgery.
BACKGROUND: Despite a lack of evidence that intentional weight loss reduces the risk of postoperative complications, adults with obesity are commonly asked to lose weight before elective surgery. We hypothesized that patients undertaking dietitian-led preoperative, very low calorie diet treatment could reduce perioperative surgery risks, as per validated risk scoring systems. The purpose of this study was to measure the impact of a dietitian-led preoperative very low calorie diet clinic on the American Society of Anesthesiologists physical status scores and National Surgical Quality Improvement Program Surgical Risk Calculator scores for patients with obesity awaiting non-bariatric elective surgery. METHODS: This retrospective cohort study included patients referred to the preoperative dietitian-led very low calorie diet clinic before elective surgical procedures over a 2-year-9-month period. The dietitian prescribed individualized, very low calorie diet-based treatment. Primary outcomes were changes in the American Society of Anesthesiologists and Surgical Risk Calculator scores from pretreatment until surgery. RESULTS: ) demonstrated clinically significant weight loss (mean 7.1 ± 6.1kg, 5.2% body weight, P < .001). Median treatment duration was 13 weeks (interquartile range 6.2-19.2 weeks). Five participants (3.5%) avoided surgery due to weight loss-related improvements in their condition. American Society of Anesthesiologists scores improved for 16% (n = 22/141) of participants. Overall, the median surgical risk calculator estimated risk of 'serious' and 'any' postoperative complication reduced from 4.8% to 3.9% (P < .001) and 6% to 5.1% (P < .001), respectively. Reduction in all Surgical Risk Calculator scores occurred, including surgical site infection, re-admission, and cardiac events (P < .05). CONCLUSION: The dietitian-led preoperative, very low calorie diet clinic improved American Society of Anesthesiologists and Surgical Risk Calculator scores for non-bariatric elective surgery patients with obesity. Randomized controlled trials comparing this approach with a control group are warranted.
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Griffin et al. (2023) conducted a cohort in Obesity awaiting elective, non-bariatric surgery (n=141). Dietitian-led preoperative very low calorie diet was evaluated on Changes in the American Society of Anesthesiologists and Surgical Risk Calculator scores from pretreatment until surgery (p=<.001). A dietitian-led preoperative very low calorie diet reduced the estimated risk of serious postoperative complications from 4.8% to 3.9% (P<.001) in patients with obesity awaiting elective surgery.
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