Comprehensive Rehabilitation Nursing Management of Bariatric Surgery: Chinese Expert Consensus

Comprehensive Rehabilitation Nursing Management of Bariatric Surgery: Chinese Expert Consensus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comprehensive Rehabilitation Nursing Management of Bariatric Surgery: Chinese Expert Consensus Lirun Kuang, Dong Xu, Yuyi Yang, Yishan Yan, Mingyang Shen, Xiaomei Chen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7033052/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Bariatric surgery is an effective treatment for obesity and metabolic disorders, yet sustainable outcomes require comprehensive perioperative strategies. In China, the emerging role of case manager in multidisciplinary teams remains underdeveloped, with inconsistent competencies and limited primary care integration. This study aimed to establish a national expert consensus to optimize rehabilitation nursing management for bariatric surgery patients. Methods A modified Delphi protocol was employed. The consensus-building process included two questionnaire rounds, quantitative evaluation via a 5-point Likert scale, and qualitative feedback. Recommendations were developed across preoperative, intraoperative, and postoperative phases, supported by literature reviews and evidence grading. Data were analyzed using SPSS 27.0, with consensus defined as ≥ 80% agreement. Results 54 multidisciplinary healthcare experts from 22 provinces nationwide were recruited. 52 recommendations were finalized, categorized into disease-specific rehabilitation, physiological function, adverse reactions, and general rehabilitation. Median ratings for all recommendations are uniformly 5, with ≥ 87% of ratings scoring 4 or 5, reflecting strong expert alignment. Weak recommendations (30% of total) often align with lower evidence quality and higher coefficient of variation values, highlighting areas needing further research. Conclusions This consensus provides a structured framework for multidisciplinary rehabilitation nursing in bariatric care, emphasizing case manager integration and evidence-based pathways. While addressing critical perioperative challenges, limitations include major hospital bias and reliance on expert opinion. Future priorities include national certification systems, scalable care models, and long-term outcome validation to enhance equitable patient management in China’s growing bariatric population. Trial registration The study is retrospectively registered at National Institute for Health and Care Research (1084722). bariatric surgery rehabilitation perioperative management consensus nursing Figures Figure 1 1. Background Bariatric surgery has been established as a successful treatment approach for obesity and associated metabolic disorders. However, growing evidence indicates that surgical procedures alone cannot fully achieve sustainable weight loss and metabolic improvements. Comprehensive postoperative strategies incorporating nutritional adjustments, exercise optimization, psychological support, and collaborative care teams prove essential for achieving lasting outcomes [ 1 ] . This evolving understanding has driven the advancement of case management frameworks - integrated care models that combine clinical specialization with tailored patient guidance across treatment phases. Globally, standardized case management systems have been operationalized in obesity management programs [ 2 , 3 ] . These structured programs employ case management nurses as central care coordinators working with multidisciplinary specialists to provide continuous, patient-centered services. Evidence indicates that implementing nursing-led case management in surgical care pathways significantly improves dietary compliance, physical activity maintenance, and postoperative rehabilitation outcomes [ 4 ] . In China's bariatric surgery field, case managers are emerging as a new professional role whose importance is gradually being recognized. However, their adoption remains low and predominantly concentrated in tertiary hospitals, with inadequate coverage in primary care settings. Current team members mostly transitioned from nurses or dietitians, lacking standardized certification systems and systematic training programs. This results in uneven professional competencies, ambiguous role boundaries, and consequently hindered efficiency in multidisciplinary coordination. This study endeavors to establish a national expert consensus on case management nursing modalities through multidisciplinary collaboration with specialists across multiple regions in China with the support of Metabolic and Bariatric Rehabiliation Professional Committee of Chinese Association of Rehabilitation Medicine and Chinese Society for Integrated Health of Metabolic and Bariatric Surgery. The primary objective is to optimize comprehensive rehabilitation management for patients undergoing bariatric surgery. 2. Methods 2.1 Study design The research framework was constructed through a three-phase consensus-building process. A preliminary focus group consultation involving five senior bariatric surgeons established preoperative prehabilitation, intraoperative management, and postoperative rehabilitation as the framework for comprehensive rehabilitation nursing management. The authors developed PICO questions and performed a principal literature search utilizing the Pubmed, EMBASE, Web of Science, Cochrane databases and Wanfang database. Based on selection criteria such as educational background, professional titles, and domain expertise, we conducted cross-regional expert selection across different regions within China. Expert consensus was systematically developed through a modified Delphi protocol comprising two iterative phases. Each recommendation statement underwent quantitative evaluation using a validated five-point Likert scale, with concurrent collection of qualitative feedback through open-text commentary fields. 2.2 Analysis This study established an evaluation index system through the Delphi method, integrating key metrics including expert engagement rate, consensus coordination, opinion centrality, and expert authority. Consensus was defined as ≥ 80% agreement for a given choice, and data were systematically analyzed using SPSS 27.0 for descriptive statistics and Kendall’s W test to validate the consistency of expert opinions and the reliability of the indicators. The Grading of Recommendations, Assessment, Development, and Evaluation process was used to assess the quality of evidence for each statement (Table S1 ) [ 5 ] . A strength of recommendation is given as either “strong” (≥ 95% agreement) or “weak” (80–95% agreement). 2.3 Ethical considerations This research was approved by the Ethics Committee of the Fourth Affiliated Hospital of China Medical University (EC-2025-KS-116). 3. Results Through a rigorous selection process, we recruited 54 multidisciplinary healthcare experts from 22 provinces nationwide, and one hundred percent of experts completed two rounds of questionnaire responses (Fig. 1 ). The participating experts comprise nursing professionals (42.59%), surgical specialists (55.56%), and clinical dietitians (1.85%). The characteristics of the selected experts are presented in Table 1 . Table 1 The characteristics of the selected experts Characteristic n (%) Gender, male 29(53.70%) Hold the position of teacher 28(51.85%) Educational background Undergraduate 25(46.30%) Graduate 15(27.78%) Doctoral 14(25.93%) Professional titles Intermediate-level 14(25.93%) Associate senior-level 12(22.22%) Full senior-level 28(51.85%) Years of Work Experience 20 33(61.11%) Through continuous comparison and analysis of the questionnaire responses, 52 recommendations were ultimately finalized. The results summarized in Table 2 present consensus recommendations for the comprehensive rehabilitation management of bariatric surgery patients, structured into four domains: disease-specific rehabilitation, physiological functional rehabilitation, adverse reaction rehabilitation, and general rehabilitation. Disease-Specific Rehabilitation dominates the framework (62% of recommendations), emphasizing preoperative assessments and system-specific protocols. Table 2 Consensus statements on comprehensive rehabilitation management of bariatric surgery Recommendations Level of evidence Strength of recommendation Percentage of rating score 4 or 5 Median IQR CV 1 Disease-specific rehabilitation 1.1 Respiratory system diseases 1.1.1 Preoperative risk assessment for OSA disease using the STOP-Bang or the Berlin questionnaire is recommended. Moderate Weak 94.4% 5 1 17.9% 1.1.2 Preoperative respiratory functional rehabilitation exercises are recommended. Moderate Strong 96.3% 5 1 17.3% 1.1.3 Smoking cessation for ≥ 2 weeks preoperatively is recommended. High Strong 96.3% 5 0 11.0% 1.2 Endocrine system diseases 1.2.1 Preoperative endocrine system assessment is mandatory. Very low Strong 100% 5 0 7.8% 1.2.2 Women of childbearing age should be prescribed contraception prior to surgery. Very low Strong 98.1% 5 0 8.0% 1.2.3 Urate-lowering medication therapy is recommended for patients suffering from gouty attacks preoperatively. Low Weak 90.7% 5 1 15.6% 1.2.4 Close postoperative monitoring of blood glucose levels is recommended, especially in diabetic patients, and medications should be adjusted according to glycemic targets. High Strong 100% 5 0 4.7% 1.2.5 It is recommended to prioritize the utilisation of intravenous insulin for glycemic control in the short-term postoperative period. Moderate Weak 87% 5 1 24.5% 1.2.6 For patients with acute gouty attacks or hyperuricemia postoperatively, urate-lowering medications can be continued according to the recommendations of specialists. Very low Weak 94.4% 5 1 13.8% 1.2.7 It is recommended that patients with hyperuricemia or gout undergo a postoperative re-evaluation of serum uric acid levels within 3 months. Very low Weak 94.4% 5 0 18.3% 1.2.8 It is recommended that women of childbearing age avoid pregnancy for 12 months postoperatively. Very low Strong 96.3% 5 0 17.5% 1.3 Circulatory system diseases 1.3.1 Preoperative cardiovascular system assessment is mandatory. Very low Strong 100% 5 0 7.0% 1.3.2 It is recommended that antiplatelet agents be discontinued 5–7 days prior to surgery, with low-molecular-weight heparin bridging therapy. Low Strong 98.1% 5 0 10.1% 1.3.3 It is recommended that patients with cardiovascular system disease and associated risks undergo a ≥ 24 hours of postoperative electrocardiographic monitoring. Moderate Strong 98.1% 5 0 15.6% 1.3.4 It is recommended that postoperative patients avoid excessive infusion and control infusion rates. Very low Weak 92.6% 5 0 12.4% 1.4 Digestive system diseases 1.4.1 Preoperative digestive system assessment is mandatory. Very low Strong 100% 5 0 8.1% 1.4.2 It is recommended that patients abstain from alcohol consumption for 2–4 weeks preoperatively. Low Weak 94.4% 5 1 20.7% 1.4.3 Postoperative use of PPIs is recommended for the treatment of GERD. Low Strong 96.3% 5 0 10.7% 1.4.4 It is recommended that oral ursodeoxycholic acid be administered in order to prevent the development of gallbladder stones postoperatively. High Weak 88.9% 5 1 24.9% 1.4.5 It is recommended that patients with MASLD undergo regular monitoring of serum lipids and ALT postoperatively. Low Strong 100% 5 0 8.5% 1.5 Psychological disorders 1.5.1 Patients diagnosed with or suspected to have psychological disorders should receive professional psychological intervention prior to surgery. Low Strong 96.3% 5 0 16.5% 1.5.2 It is recommended to continue monitoring mental health status postoperatively and maintain the preoperative psychological assessment measures. Low Strong 96.3% 5 1 11.8% 1.5.3 For patients experiencing psychological health issues postoperatively, psychological counseling and behavioral interventions delivered by a psychotherapist are recommended. Low Strong 98.1% 5 0 9.4% 1.5.4 Timely psychiatric referral is recommended for patients presenting with severe psychological health complications following surgery. Very low Weak 88.9% 5 0 19.5% 2 Physiological functional rehabilitation 2.1 Physical and functional exercise 2.1.1 Preoperative evaluation of physical exercise capacity and its limitations is required. Very low Weak 94.4% 5 1 12.3% 2.1.2 Early postoperative ambulation is recommended. Low Strong 100% 5 0 6.0% 2.1.3 It is recommended that patients engage in at least 150 minutes of moderate intensity aerobic exercise per week within the first 6 weeks postoperatively, progressing to 150–300 minutes of moderate-to-vigorous intensity aerobic exercise weekly beginning at 8 weeks post-surgery. High Weak 90.7% 5 1 20.7% 2.1.4 It is recommended that postoperative regular evaluations of exercise efficacy and compliance be conducted to optimize exercise regimens. Very low Strong 98.1% 5 1 10.8% 2.2 Diet and Nutrition 2.2.1 Comprehensive preoperative nutritional evaluation is mandatory. High Strong 100% 5 0 6.5% 2.2.2 Preoperatively, a low-calorie diet is recommended to improve blood glucose, lipid levels, body weight, and other related indicators. Moderate Weak 92.6% 5 0 18.0% 2.2.3 Early oral feeding is encouraged postoperatively. Low Strong 96.3% 5 0 12.6% 2.2.4 Postoperative dietary management should adhere to phased transition protocols to reinstate normal diet. Very low Strong 100% 5 0 6.0% 2.2.5 Postoperatively, a daily fluid intake of ≥ 1500mL is recommended. Very low Strong 96.3% 5 0 12.2% 2.2.6 Postoperatively, alcohol abstinence education is recommended to prevent alcohol consumption. Low Weak 94.4% 5 1 12.6% 2.2.7 Adequate dietary intake of protein, vitamins, and essential minerals should be ensured postoperatively. Moderate Strong 100% 5 0 3.8% 2.2.8 Postoperative metabolic and nutritional status monitoring should be routinely performed. High Strong 100% 5 0 2.7% 2.3 Weight 2.3.1 It is recommended that high-risk patients (including those with super obesity, diabetes, cardiopulmonary dysfunction and other comorbidities) receive preoperative weight reduction treatment before surgery. Moderate Strong 100% 5 0 6.5% 2.3.2 The %EWL and %TWL is recommended as metrics for assessing weight loss efficacy postoperatively. Low Strong 100% 5 0 4.7% 2.3.3 Postoperative patients experiencing weight regain or suboptimal weight loss outcomes require systematic etiological evaluation followed by implementation of multidimensional intervention strategies encompassing dietary modifications, exercise regimens, and behavioral therapy for sustainable weight management. Moderate Strong 100% 5 0 7.8% 2.3.4 Patients demonstrating suboptimal postoperative weight loss are recommended for pharmacotherapy or revisional surgery following systematic clinical evaluation. Moderate Strong 98.1% 5 0 8.4% 3 Adverse reaction rehabilitation 3.1 Pain 3.1.1 The implementation of multimodal analgesia protocols is recommended postoperatively. Moderate Strong 96.3% 5 0 9.6% 3.2 PONV 3.2.1 Preoperative assessment of PONV risk factors should be conducted. Low Weak 92.6% 5 1 13.3% 3.3 VTE 3.3.1 Preoperative VTE risk assessment is mandatory. Low Strong 100% 5 0 3.8% 3.3.2 Discontinuation of estrogen-containing contraceptives for 1 month and HRT for 3 weeks prior to surgery is recommended to mitigate perioperative VTE. Very low Weak 92.6% 5 1 13.3% 3.3.3 Preoperative VTE prophylaxis measures, including mechanical or pharmacological methods, should be implemented. Moderate Weak 92.6% 5 0 13.0% 3.3.4 It is recommended to repeat the VTE risk assessment within 6 hours postoperatively. Very low Strong 96.3% 5 0 10.5% 3.3.5 Mechanical prophylaxis is recommended for postoperative patients at low risk of VTE. Low Weak 90.7% 5 1 14.0% 3.3.6 Combined mechanical and pharmacological prophylaxis for high VTE risk patients Low Strong 100% 5 0 7.8% 3.4 Stress ulcer 3.4.1 If NSAIDs must be used postoperatively, combine with PPIs for stress ulcer prophylaxis. Low Strong 98.1% 5 0 8.8% 4 General rehabilitation 4.1 Body temperature 4.1.1 It is recommended to monitor core body temperature during surgery and employ a warming and insulation system. Moderate Strong 96.3% 5 0 11.2% 4.2 Skin 4.2.1 Preoperative pressure ulcer risk assessment is recommended. Very low Weak 92.6% 5 0 14.1% 4.2.2 It is recommended to select an appropriate surgical table and mattress to prevent intraoperative pressure ulcers. Very low Strong 96.3% 5 0 10.5% Abbreviations: obstructive sleep apnea, OSA; proton pump inhibitors, PPIs; gastroesophageal reflux disease, GERD; metabolic dysfunction-associated steatotic liver disease, MASLD; alanine aminotransferase, ALT; percentage of excess weight loss, %EWL; percentage of total weight loss, %TWL; postoperative nausea and vomiting, PONV; venous thromboembolism, VTE; hormone replacement therapy, HRT; nonsteroidal anti-inflammatory drugs, NSAIDs; IQR, interquartile range; coefficient of variation, CV. Over 50% of recommendations are supported by Low or Very Low evidence levels, yet 70% carry strong recommendations, indicating reliance on expert consensus despite limited evidence. Median ratings for all recommendations are uniformly 5, with ≥ 87% of ratings scoring 4 or 5, reflecting strong expert alignment. Higher coefficient of variation values (15–25%) correlate with weaker recommendations (e.g., urate-lowering therapy, exercise regimens), suggesting less uniformity in expert opinions. Weak recommendations (30% of total) often align with lower evidence quality and higher CV values, highlighting areas needing further research. 4. Discussion Perioperative management of patients undergoing bariatric surgery necessitates a comprehensive multidisciplinary approach to address the complex interactions between obesity-related comorbidities, altered physiological adaptations, and inherent surgical risks. This consensus statement outlines essential strategies for optimizing rehabilitation nursing management with particular emphasis on integrating evidence-based clinical pathways and fostering multidisciplinary team (MDT) collaboration. 4.1 Disease-Specific Rehabilitation Respiratory System Respiratory complications, particularly obstructive sleep apnea (OSA), represent a significant perioperative risk in bariatric populations. The utilization of validated screening tools such as the STOP-Bang and Berlin questionnaires ensures early identification of OSA, with polysomnography confirmation guiding severity stratification and therapeutic interventions [ 6 – 8 ] . Preoperative continuous positive airway pressure (CPAP) not only mitigates perioperative hypoxia but also reduces postoperative cardiopulmonary complications, particularly in patients with moderate-to-severe OSA [ 7 , 9 ] . The emphasis on smoking cessation, respiratory rehabilitation exercises, and patient education aligns with evidence demonstrating improved pulmonary function and reduced postoperative morbidity [ 8 , 10 – 13 ] . Intraoperative adherence to airway management guidelines, including semi-upright positioning and prolonged intubation monitoring in high-risk cases, further minimizes respiratory compromise [ 7 , 14 ] . The patient's posture during the postoperative period should be either head-up or semi-recumbent [ 12 , 15 ] . For patients exhibiting combined respiratory failure and hypoxemia, the administration of high-flow nasal cannula is an option to be considered, and the patient can be assisted with exercises such as effective coughing and deep breathing, in addition to the use of respiratory trainers to exercise lung function [ 12 , 15 ] . For patients diagnosed with OSA who are routinely or temporarily treated with CPAP preoperatively, CPAP can be continued postoperatively or even 3–6 months after discharge, and the duration of treatment can be determined based on the results of the polysomnography evaluation [ 7 , 8 ] . Long-term follow-up ensures sustained management of respiratory system diseases, reflecting the dynamic nature of weight loss on respiratory pathophysiology. Endocrine System Endocrine system disorders, notably diabetes, require meticulous preoperative optimization and postoperative surveillance [ 16 ] . Female patients should be aware of the status of their menstrual cycles over the past 12 months, and female patients of childbearing age should be counseled to take the necessary contraceptive measures prior to the surgery [ 16 , 17 ] . The prevailing opinion suggests that preoperative blood glucose levels should not be mandated as an absolute prerequisite for performing bariatric surgery [ 18 ] . However, it remains advisable to collaborate with endocrinologists in developing personalized glycemic control regimens preoperatively, supplemented by continuous glucose monitoring devices for real-time glucose tracking [ 18 – 20 ] . Patients are advised to discontinue existing hypoglycemic agents preoperatively to facilitate medical transition to short-acting insulin therapy under clinical supervision [ 6 , 8 , 16 , 21 ] . Postoperative blood glucose management should target 7.8–10.0 mmol/L as the target control range [ 8 ] . For hospitalized patients exceeding this glycemic threshold, short-term intravenous insulin therapy should be prioritized. Post-discharge care requires intensified blood glucose monitoring with periodic follow-up assessments, followed by long-term surveillance to evaluate progression of diabetes-related complications [ 8 ] Hyperuricemia management, through urate-lowering therapy and hydration protocols, addresses the dual challenges of acute gout flares and long-term metabolic adaptations post-surgery [ 22 ] . To effectively manage hyperuricemia and gout exacerbation preoperatively, alcohol abstinence is mandatory prior to hospitalization. Bariatric surgery exerts significant impacts on hyperuricemia and gout, necessitating comprehensive patient education postoperatively, including perioperative hydration maintenance, early physical rehabilitation, and minimization of diuretic use [ 22 , 23 ] . Regular monitoring of serum uric acid levels and assessment of gout-related symptoms should be performed postoperatively. For reproductive-aged women, particularly those with polycystic ovary syndrome, postoperative hormonal reassessment and contraceptive counseling are critical, given the rapid metabolic changes influencing fertility and menstrual regularity [ 8 , 24 , 25 ] . Circulatory System Cardiovascular risk stratification, incorporating functional capacity assessments, ensures safe surgical candidacy [ 18 , 26 – 29 ] . Cardiac function can be assessed in a variety of ways, including cardiac function classification (e.g., NYHA classification, Killip classification, Forrest classification), left ventricular ejection fraction, noninvasive cardiopulmonary exercise test, 6-minute walk test, and modified cardiac risk assessment index [ 18 , 27 – 29 ] . The assessment of activity endurance should be evaluated to determine whether it meets or exceeds 4 metabolic equivalents. In cases where activity endurance is < 4 metabolic equivalents or presenting with cardiovascular risk factors, further assessment of cardiac function is necessary [ 29 ] . If deemed necessary, pharmacologic or exercise stress testing is performed to evaluate myocardial ischemia [ 29 ] . Bridging anticoagulation protocols for patients on antiplatelet therapy and hemodynamic optimization in hypertension or heart failure mitigate perioperative thromboembolic and ischemic events [ 26 , 29 ] . Postoperative monitoring of hemodynamic parameters in high-risk patients, coupled with graded mobilization to prevent orthostatic hypotension, reflects a proactive approach to cardiovascular stability. Patients suffering from severe obesity in combination with heart disease face an elevated risk of developing postoperative cardiovascular complications. It is therefore recommended that continuous postoperative monitoring of electrocardiogram, blood pressure, heart rate, and peripheral oxygen saturation is conducted for a period of more than 24 hours [ 30 ] . Long-term follow-up evaluations at standardized intervals enable early detection of weight loss-associated cardiac remodeling or residual cardiovascular dysfunction, facilitating timely intervention. Digestive System Preoperative screening for gastroesophageal reflux disease (GERD), Helicobacter pylori ( H. pylori ), and metabolic dysfunction-associated steatotic liver disease (MASLD) informs surgical technique selection and prophylactic measures. Smoking and alcohol cessation are required preoperatively, with a minimum abstinence period of 2–4 weeks for alcohol [ 8 , 31 – 33 ] . In patients with alcoholism, strict abstinence from alcohol for 1–2 years has been shown to reduce the risks associated with surgery [ 12 ] . In MASLD, serial monitoring of alanine aminotransferase (ALT) and lipid profiles is critical, with ALT reduction ≥ 17 U/L indicating histologic improvement [ 33 ] . The emphasis on alcohol abstinence and dietary modifications preoperatively, combined with serial liver function monitoring postoperatively, underscores the bidirectional relationship between bariatric surgery and hepatic metabolic health. In addition, patients suffering from comorbidities such as GERD or cholelithiasis are advised to avoid foods that may trigger symptoms and are instructed to adhere to a low-fat, low-calorie diet, with meals consumed at regular intervals and in measured quantities, in order to prevent the recurrence of episodes of the disease [ 34 , 35 ] . Ursodeoxycholic acid administration post-surgery effectively reduces cholelithiasis incidence, while proton pump inhibitors (PPIs) and lifestyle modifications address GERD exacerbations [ 8 , 12 , 34 ] . Endoscopic surveillance in symptomatic patients ensures early detection of anastomotic complications or ulcerations, particularly in malabsorptive procedures [ 8 , 24 , 34 ] . Psychological Disorders The bidirectional impact of bariatric surgery on mental health necessitates rigorous preoperative psychological evaluation and postoperative support [ 36 – 44 ] . Preoperative education and informational support are critical to enhance patient understanding, establish realistic expectations, and alleviate anxiety or fear regarding the procedure. Patients should be counseled on the psychological benefits of surgery while acknowledging its limitations in treating pre-existing mental health conditions. Cognitive-behavioral interventions preoperatively enhance surgical readiness, while long-term monitoring for psychiatric comorbidities (e.g., depression, substance abuse) addresses the paradox of improved metabolic health coexisting with psychological distress [ 45 – 48 ] . Patients demonstrating poor adherence to treatment guidelines, maladaptive stress management, negative emotions, disordered eating patterns, weight regain, or severe psychiatric conditions (e.g., major depression, severe eating disorders, suicidal behaviour, or substance dependence) should be promptly referred to psychiatric care [ 45 – 48 ] . In patients requiring continued psychotropic medications postoperatively, case managers and clinicians must monitor for adverse metabolic effects, including hyperglycemia, dyslipidemia, and weight gain, which may counteract surgical outcomes. Regular assessment of drug efficacy and side effects is essential to balance mental health management with metabolic preservation. 4.2 Physiological Functional Rehabilitation Physical and Functional Exercise Preoperative exercise programs targeting aerobic capacity and musculoskeletal strength reduce surgical complications and enhance postoperative recovery [ 49 – 52 ] . The phased postoperative rehabilitation protocol, progressing from early ambulation to resistance training, prioritizes functional independence while mitigating muscle atrophy [ 8 , 33 , 53 – 57 ] . The integration of validated assessment tools (e.g., Borg scale, Berg Balance Scale) ensures objective monitoring of rehabilitation efficacy [ 8 , 58 , 59 ] . However, challenges persist in maintaining long-term exercise adherence, necessitating individualized strategies that address motivational barriers and physical limitations. Diet and Nutrition A personalised diet plan should be developed in consultation with a dietician, emphasising a high-protein, low-calorie, low-sugar, low-fat diet, limiting carbohydrates, supplementing vitamins and micronutrients, and maintaining adequate hydration [ 60 ] . Preoperative implementation of a low-calorie diet (1000–1200 kcal/day) or very low-calorie diet (400–800 kcal/day) may improve metabolic parameters such as blood glucose and lipid levels, facilitating effective weight control [ 61 , 62 ] . Although studies suggest that preoperative intake of carbohydrate-rich beverages up to 2 hours before surgery enhances recovery and reduces hospitalization time without increasing postoperative complications, this practice remains controversial in domestic clinical settings [ 12 , 63 ] . Postoperatively, early oral feeding is encouraged to shorten fasting duration, with a recommended daily fluid intake of ≥ 1500 ml [ 9 , 64 , 65 ] . Dietary progression should follow a structured transition from clear liquids to semi-liquid, soft, and finally solid food. During the initial three postoperative months, supplemental administration of whey protein powder is advised to optimize protein adequacy. Concurrently, comprehensive micronutrient supplementation is mandatory, including full-spectrum multivitamins and essential trace mineral formulations (Table 3 ) [ 8 , 66 – 68 ] . Rapidly absorbed carbohydrates and prolonged fasting should be avoided to prevent late dumping syndrome [ 69 ] Table 3 Vitamin and mineral supplementation after bariatric surgery Vitamin and mineral Supplementation Vitamin B1 [ 67 , 68 ] ≥ 12 mg/day Vitamin B12 [ 67 , 68 ] 350–500 µg/day Vitamin D [ 66 – 68 ] 3000 U/day Vitamin A [ 8 , 67 ] 5000–10000 U/day Vitamin E [ 8 , 67 ] 15 mg/day Vitamin K [ 8 ] 90–120 µg/day Calcium [ 67 , 68 ] 1200–1500 mg/day Folic acid [ 8 , 68 ] 400–800 µg/day 800–1000 µg/day for pregnant women Iron [ 67 , 68 ] 18 mg/day for low risk patients 45–60 mg/day for high risk patients Zinc [ 67 , 68 ] SG: 8–11 mg/day RYGB: 8 ~ 22 mg/day Copper [ 8 , 67 ] SG: 1 mg/day RYGB: 2 mg/day For patients with hyperuricemia or gout, collaborative management with a nutritionist is recommended to implement controlled protein intake, with specific restrictions on red meat, animal offal, seafood, and legumes, alongside increased fluid intake to promote uric acid excretion [ 22 ] . Postoperative care should incorporate structured patient education regarding the modest elevation in alcohol misuse risk associated with metabolic adaptations, emphasizing alcohol abstinence [ 64 , 70 ] . Additionally, patients require guidance on potential medication adherence challenges and strategies to accommodate surgically induced alterations in dietary patterns [ 18 ] . Long-term surveillance for deficiencies (e.g., iron, vitamin B12, calcium) is critical, particularly in malabsorptive procedures, necessitating lifelong supplementation and dietary counseling [ 64 , 66 , 67 , 71 – 73 ] . Weight Preoperative weight loss therapy for high-risk patients (including those with super obesity, diabetes, cardiopulmonary dysfunction and other comorbidities) is recommended, targeting a 5%-10% reduction in body mass to optimize surgical outcomes, which may reduce liver volume, shorten operative duration, lower postoperative complication rates, and decrease 30-day mortality [ 12 , 61 , 62 ] . Long-term postoperative surveillance and continuous patient education is critical to evaluate sustained weight loss and prevent weight regain [ 64 ] . The percentage of excess weight loss (%EWL) and total weight loss (%TWL) serve as validated metrics for assessing therapeutic efficacy during follow-up [ 74 – 76 ] . Factors influencing postoperative weight loss, including hormonal profiles, psychological status, dietary patterns, adherence, and eating behaviors, should be systematically evaluated. For patients experiencing suboptimal weight loss or weight regain, targeted interventions (e.g., dietary modification, exercise regimens, and behavioral therapy) should be implemented [ 64 , 77 ] . In cases of inadequate metabolic improvement or significant weight regain, MDT evaluation is recommended to determine the appropriateness of adjunctive pharmacotherapy (e.g., semaglutide or liraglutide) or revisional surgery [ 24 , 78 – 80 ] 4.3 Adverse Reaction Rehabilitation Pain and postoperative nausea and vomiting (PONV) Multimodal analgesia, minimizing opioid use through regional blocks and non-steroidal anti-inflammatory drugs (NSAIDs), addresses the dual challenges of effective pain control and reduced emetogenic risk [ 12 , 81 , 82 ] . The 19.5% incidence of PONV mandates risk stratification (e.g., Apfel score) and prophylactic antiemetics, particularly in high-risk cohorts [ 83 – 86 ] . Refractory cases require exclusion of mechanical obstructions, highlighting the importance of vigilant postoperative monitoring [ 86 , 87 ] . Venous Thromboembolism (VTE) Combined mechanical and pharmacological prophylaxis, guided by preoperative risk assessment, reduces the VTE incidence in bariatric surgery [ 8 , 62 , 88 , 89 ] . Patients should consider discontinuing estrogen-containing oral contraceptives for 1 month and hormone replacement therapy (HRT) for 3 weeks preoperatively to reduce the risk of VTE [ 18 ] . VTE risk should be re-assessed within 6 hours post-surgery and functional mobility training should be performed. Patient education on early mobilization and compression stocking therapy fosters adherence to preventive measures [ 90 ] . Extended post-discharge anticoagulation in high-risk patients, coupled with D-dimer surveillance, balances thrombotic and hemorrhagic risks [ 88 , 89 ] . Stress Ulcers PPIs prophylaxis has been demonstrated to reduce the risk of ulceration, particularly in patients with preoperative GERD or who have been prescribed NSAIDs [ 91 – 93 ] . Postoperative dietary modifications and avoidance of gastric irritants synergize with pharmacotherapy to protect mucosal integrity. 4.4 General Rehabilitation Thermoregulatory management, through preoperative warming and intraoperative fluid heating, prevents hypothermia-related complications [ 94 – 99 ] . Skin care protocols, addressing pressure ulcer risks intraoperatively and excess skin management postoperatively, enhance patient comfort and reduce infection risks [ 100 – 103 ] . Reconstructive surgery, deferred until weight stabilization, improves psychosocial outcomes in patients with significant skin laxity [ 104 ] . 4.5 Limitation This consensus has several limitations. First, the expert panel predominantly comprised professionals from major hospitals, potentially underrepresenting primary care perspectives. Regional disparities and variations in healthcare resources may limit the generalizability of recommendations. Second, over 50% of statements were supported by low or very low evidence, reflecting reliance on expert opinion rather than robust clinical data. Third, the study lacks long-term follow-up data to validate the sustainability of proposed interventions, particularly regarding weight maintenance and psychological outcomes. Additionally, cultural and socioeconomic factors influencing patient adherence (e.g., dietary habits, access to rehabilitation services) were not thoroughly explored. Finally, the consensus process did not incorporate patient perspectives, potentially overlooking experiential insights critical to patient-centered care. Future efforts should aim for broader stakeholder inclusion, higher-quality evidence generation, and pragmatic strategies to overcome systemic and contextual challenges in diverse healthcare settings. 5. Conclusion This consensus establishes a framework for comprehensive rehabilitation nursing management in China, emphasizing integrated perioperative care. Through a Delphi-based process, consensus was formulated across disease-specific rehabilitation, physiological function, adverse reactions, and general rehabilitation. The consensus advocates expanding case manager roles and integrating primary care. Future efforts should focus on establishing evidence-based guidelines, national certification systems, and scalable care models to ensure equitable, sustainable outcomes in China’s growing bariatric population. This establishes a foundation for advancing evidence-based guidelines, national certification programs, and scalable care models. Abbreviations ALT alanine aminotransferase CPAP continuous positive airway pressure GERD gastroesophageal reflux disease HRT hormone replacement therapy MASLD metabolic dysfunction-associated steatotic liver disease MDT multidisciplinary team NSAIDs non-steroidal anti-inflammatory drugs OSA obstructive sleep apnea PONV postoperative nausea and vomiting PPIs proton pump inhibitors VTE venous thromboembolism %EWL percentage of excess weight loss %TWL percentage total weight loss Declarations Ethics approval and consent to participate The study is retrospectively registered at National Institute for Health and Care Research (1084722). This research was approved by the Ethics Committee of the Fourth Affiliated Hospital of China Medical University (EC-2025-KS-116). A written informed consent is obtained from all participants before inclusion in the study. All participants are informed that they can withdraw from the study at any time without giving a reason. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Clinical trial number Not applicable. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution LRK: writing the original draft, analysis of data, methodology. DX: analysis of data, methodology. YYY: analysis of data, methodology. YSY: analysis of data, methodology. MYS: review and editing of final draft. XMC: project administration, editing the final draft. LLS: project administration, editing the final draft. YW: project administration, editing the final draft. HYX: project administration, editing the final draft. All authors read and approved the final manuscript. Acknowledgement We would like to extend our sincere gratitude to Ningli Yang, Lilian Gao, Lin Yao, Ronghui Du, Yanmin Du, Yue Wen, Xia Zhang, Dafang Zhan, Yunqing Li, Rongyuan Jiang, Qiyun Chen, Meng Zhang, Haiying Li, Jiarui Li, and Yuanmin Gao for their professional guidance and technical support throughout this research. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Berger NK, Carr JJ, Erickson J, Gourash WF, Muenzen P, Smolenak L, et al. Path to bariatric nurse certification: the practice analysis. Surg Obes Relat Dis. 2010;6(4):399–407. https://doi.org/10.1016/j.soard.2010.04.003 . Woodward J, Rice E. Case Management. Nurs Clin North Am. 2015;50(1):109–21. https://doi.org/10.1016/j.cnur.2014.10.009 . Trueman SWT. Case management down under. Prof case Manage. 2011;16(4):217–217. https://doi.org/10.1097/NCM.0b013e31821dbab0 . 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Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655–64. https://doi.org/10.1016/s0140-6736(15)00981-2 . Balki I, Khan JS, Staibano P, Duceppe E, Bessissow A, Sloan EN, et al. Effect of Perioperative Active Body Surface Warming Systems on Analgesic and Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2020;131(5):1430–43. https://doi.org/10.1213/ane.0000000000005145 . Brodshaug I, Tettum B, Raeder J. Thermal Suit or Forced Air Warming in Prevention of Perioperative Hypothermia: A Randomized Controlled Trial. J Perianesth Nurs. 2019;34(5):1006–15. https://doi.org/10.1016/j.jopan.2019.03.002 . Okoue R, Calabrese D, Nze P, Msika S, Keita H. Efficacy of Forced-Air Warming to Prevent Perioperative Hypothermia in Morbidly-Obese Versus Non-obese Patients. Obes Surg. 2018;28(7):1955–9. https://doi.org/10.1007/s11695-017-3108-5 . Nieh HC, Su SF. Meta-analysis: effectiveness of forced-air warming for prevention of perioperative hypothermia in surgical patients. J Adv Nurs. 2016;72(10):2294–314. https://doi.org/10.1111/jan.13010 . Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol. 2019;81(5):1037–57. https://doi.org/10.1016/j.jaad.2018.12.070 . Derderian SC, Dewberry LC, Patten L, Sitzman TJ, Kaizer AM, Jenkins TM, et al. Excess skin problems among adolescents after bariatric surgery. Surg Obes Relat Dis. 2020;16(8):993–8. https://doi.org/10.1016/j.soard.2020.04.020 . Soleimanpour H, Safari S, Sanaie S, Nazari M, Alavian SM. Anesthetic Considerations in Patients Undergoing Bariatric Surgery: A Review Article. Anesthesiology pain Med. 2017;7(4):e57568–57568. https://doi.org/10.5812/aapm.57568 . Rosen J, Darwin E, Tuchayi SM, Garibyan L, Yosipovitch G. Skin changes and manifestations associated with the treatment of obesity. J Am Acad Dermatol. 2019;81(5):1059–69. https://doi.org/10.1016/j.jaad.2018.10.081 . Biörserud C, Nielsen C, Staalesen T, Elander A, Olbers T, Olsén MF. Sahlgrenska Excess Skin Questionnaire (SESQ): a reliable questionnaire to assess the experience of excessive skin after weight loss. J Plast Surg Hand Surg. 2013;47(1):50–9. https://doi.org/10.3109/2000656x.2012.731001 . Additional Declarations No competing interests reported. Supplementary Files TableS1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":124015,"visible":true,"origin":"","legend":"\u003cp\u003eGeographic distribution of consensus participants across China.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7033052/v1/0b03e528fa2dbadd6a8600f9.jpeg"},{"id":109168302,"identity":"0e382d94-3172-46ae-bf9b-aea1f19f2b53","added_by":"auto","created_at":"2026-05-13 08:33:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":838867,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7033052/v1/e9d7b24e-b291-481e-8176-e8d8434e22f0.pdf"},{"id":93335919,"identity":"cb0752fc-5cd2-41c1-86fe-18a4a30a033b","added_by":"auto","created_at":"2025-10-12 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Background","content":"\u003cp\u003eBariatric surgery has been established as a successful treatment approach for obesity and associated metabolic disorders. However, growing evidence indicates that surgical procedures alone cannot fully achieve sustainable weight loss and metabolic improvements. Comprehensive postoperative strategies incorporating nutritional adjustments, exercise optimization, psychological support, and collaborative care teams prove essential for achieving lasting outcomes \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. This evolving understanding has driven the advancement of case management frameworks - integrated care models that combine clinical specialization with tailored patient guidance across treatment phases. Globally, standardized case management systems have been operationalized in obesity management programs \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. These structured programs employ case management nurses as central care coordinators working with multidisciplinary specialists to provide continuous, patient-centered services. Evidence indicates that implementing nursing-led case management in surgical care pathways significantly improves dietary compliance, physical activity maintenance, and postoperative rehabilitation outcomes \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eIn China's bariatric surgery field, case managers are emerging as a new professional role whose importance is gradually being recognized. However, their adoption remains low and predominantly concentrated in tertiary hospitals, with inadequate coverage in primary care settings. Current team members mostly transitioned from nurses or dietitians, lacking standardized certification systems and systematic training programs. This results in uneven professional competencies, ambiguous role boundaries, and consequently hindered efficiency in multidisciplinary coordination.\u003c/p\u003e\u003cp\u003eThis study endeavors to establish a national expert consensus on case management nursing modalities through multidisciplinary collaboration with specialists across multiple regions in China with the support of Metabolic and Bariatric Rehabiliation Professional Committee of Chinese Association of Rehabilitation Medicine and Chinese Society for Integrated Health of Metabolic and Bariatric Surgery. The primary objective is to optimize comprehensive rehabilitation management for patients undergoing bariatric surgery.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design\u003c/h2\u003e\u003cp\u003eThe research framework was constructed through a three-phase consensus-building process. A preliminary focus group consultation involving five senior bariatric surgeons established preoperative prehabilitation, intraoperative management, and postoperative rehabilitation as the framework for comprehensive rehabilitation nursing management. The authors developed PICO questions and performed a principal literature search utilizing the Pubmed, EMBASE, Web of Science, Cochrane databases and Wanfang database. Based on selection criteria such as educational background, professional titles, and domain expertise, we conducted cross-regional expert selection across different regions within China. Expert consensus was systematically developed through a modified Delphi protocol comprising two iterative phases. Each recommendation statement underwent quantitative evaluation using a validated five-point Likert scale, with concurrent collection of qualitative feedback through open-text commentary fields.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Analysis\u003c/h2\u003e\u003cp\u003eThis study established an evaluation index system through the Delphi method, integrating key metrics including expert engagement rate, consensus coordination, opinion centrality, and expert authority. Consensus was defined as \u0026ge;\u0026thinsp;80% agreement for a given choice, and data were systematically analyzed using SPSS 27.0 for descriptive statistics and Kendall\u0026rsquo;s W test to validate the consistency of expert opinions and the reliability of the indicators. The Grading of Recommendations, Assessment, Development, and Evaluation process was used to assess the quality of evidence for each statement (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e) \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. A strength of recommendation is given as either \u0026ldquo;strong\u0026rdquo; (\u0026ge;\u0026thinsp;95% agreement) or \u0026ldquo;weak\u0026rdquo; (80\u0026ndash;95% agreement).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Ethical considerations\u003c/h2\u003e\u003cp\u003eThis research was approved by the Ethics Committee of the Fourth Affiliated Hospital of China Medical University (EC-2025-KS-116).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThrough a rigorous selection process, we recruited 54 multidisciplinary healthcare experts from 22 provinces nationwide, and one hundred percent of experts completed two rounds of questionnaire responses (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The participating experts comprise nursing professionals (42.59%), surgical specialists (55.56%), and clinical dietitians (1.85%). The characteristics of the selected experts are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe characteristics of the selected experts\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender, male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(53.70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHold the position of teacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(51.85%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEducational background\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(46.30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(27.78%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoctoral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(25.93%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eProfessional titles\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(25.93%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate senior-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(22.22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull senior-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(51.85%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYears of Work Experience\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.85%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026thinsp;~\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(20.37%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026thinsp;~\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(16.67%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(61.11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThrough continuous comparison and analysis of the questionnaire responses, 52 recommendations were ultimately finalized. The results summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e present consensus recommendations for the comprehensive rehabilitation management of bariatric surgery patients, structured into four domains: disease-specific rehabilitation, physiological functional rehabilitation, adverse reaction rehabilitation, and general rehabilitation. Disease-Specific Rehabilitation dominates the framework (62% of recommendations), emphasizing preoperative assessments and system-specific protocols.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConsensus statements on comprehensive rehabilitation management of bariatric surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecommendations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel of evidence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrength of recommendation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage of rating score 4 or 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIQR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCV\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1 Disease-specific rehabilitation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1.1 Respiratory system diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1.1 Preoperative risk assessment for OSA disease using the STOP-Bang or the Berlin questionnaire is recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1.2 Preoperative respiratory functional rehabilitation exercises are recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1.3 Smoking cessation for \u0026ge;\u0026thinsp;2 weeks preoperatively is recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1.2 Endocrine system diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.1 Preoperative endocrine system assessment is mandatory.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.2 Women of childbearing age should be prescribed contraception prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.3 Urate-lowering medication therapy is recommended for patients suffering from gouty attacks preoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.4 Close postoperative monitoring of blood glucose levels is recommended, especially in diabetic patients, and medications should be adjusted according to glycemic targets.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.5 It is recommended to prioritize the utilisation of intravenous insulin for glycemic control in the short-term postoperative period.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.6 For patients with acute gouty attacks or hyperuricemia postoperatively, urate-lowering medications can be continued according to the recommendations of specialists.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.7 It is recommended that patients with hyperuricemia or gout undergo a postoperative re-evaluation of serum uric acid levels within 3 months.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.8 It is recommended that women of childbearing age avoid pregnancy for 12 months postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1.3 Circulatory system diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.1 Preoperative cardiovascular system assessment is mandatory.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.2 It is recommended that antiplatelet agents be discontinued 5\u0026ndash;7 days prior to surgery, with low-molecular-weight heparin bridging therapy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.3 It is recommended that patients with cardiovascular system disease and associated risks undergo a\u0026thinsp;\u0026ge;\u0026thinsp;24 hours of postoperative electrocardiographic monitoring.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.4 It is recommended that postoperative patients avoid excessive infusion and control infusion rates.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1.4 Digestive system diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.1 Preoperative digestive system assessment is mandatory.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.2 It is recommended that patients abstain from alcohol consumption for 2\u0026ndash;4 weeks preoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.3 Postoperative use of PPIs is recommended for the treatment of GERD.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.4 It is recommended that oral ursodeoxycholic acid be administered in order to prevent the development of gallbladder stones postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.5 It is recommended that patients with MASLD undergo regular monitoring of serum lipids and ALT postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1.5 Psychological disorders\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.5.1 Patients diagnosed with or suspected to have psychological disorders should receive professional psychological intervention prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.5.2 It is recommended to continue monitoring mental health status postoperatively and maintain the preoperative psychological assessment measures.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.5.3 For patients experiencing psychological health issues postoperatively, psychological counseling and behavioral interventions delivered by a psychotherapist are recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.5.4 Timely psychiatric referral is recommended for patients presenting with severe psychological health complications following surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2 Physiological functional rehabilitation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2.1 Physical and functional exercise\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.1.1 Preoperative evaluation of physical exercise capacity and its limitations is required.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.1.2 Early postoperative ambulation is recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.1.3 It is recommended that patients engage in at least 150 minutes of moderate intensity aerobic exercise per week within the first 6 weeks postoperatively, progressing to 150\u0026ndash;300 minutes of moderate-to-vigorous intensity aerobic exercise weekly beginning at 8 weeks post-surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.1.4 It is recommended that postoperative regular evaluations of exercise efficacy and compliance be conducted to optimize exercise regimens.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2.2 Diet and Nutrition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.1 Comprehensive preoperative nutritional evaluation is mandatory.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.2 Preoperatively, a low-calorie diet is recommended to improve blood glucose, lipid levels, body weight, and other related indicators.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.3 Early oral feeding is encouraged postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.4 Postoperative dietary management should adhere to phased transition protocols to reinstate normal diet.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.5 Postoperatively, a daily fluid intake of \u0026ge;\u0026thinsp;1500mL is recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.6 Postoperatively, alcohol abstinence education is recommended to prevent alcohol consumption.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.7 Adequate dietary intake of protein, vitamins, and essential minerals should be ensured postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2.8 Postoperative metabolic and nutritional status monitoring should be routinely performed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2.3 Weight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.3.1 It is recommended that high-risk patients (including those with super obesity, diabetes, cardiopulmonary dysfunction and other comorbidities) receive preoperative weight reduction treatment before surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.3.2 The %EWL and %TWL is recommended as metrics for assessing weight loss efficacy postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.3.3 Postoperative patients experiencing weight regain or suboptimal weight loss outcomes require systematic etiological evaluation followed by implementation of multidimensional intervention strategies encompassing dietary modifications, exercise regimens, and behavioral therapy for sustainable weight management.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.3.4 Patients demonstrating suboptimal postoperative weight loss are recommended for pharmacotherapy or revisional surgery following systematic clinical evaluation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3 Adverse reaction rehabilitation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3.1 Pain\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.1.1 The implementation of multimodal analgesia protocols is recommended postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3.2 PONV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.2.1 Preoperative assessment of PONV risk factors should be conducted.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3.3 VTE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.1 Preoperative VTE risk assessment is mandatory.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.2 Discontinuation of estrogen-containing contraceptives for 1 month and HRT for 3 weeks prior to surgery is recommended to mitigate perioperative VTE.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.3 Preoperative VTE prophylaxis measures, including mechanical or pharmacological methods, should be implemented.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.4 It is recommended to repeat the VTE risk assessment within 6 hours postoperatively.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.5 Mechanical prophylaxis is recommended for postoperative patients at low risk of VTE.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.3.6 Combined mechanical and pharmacological prophylaxis for high VTE risk patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3.4 Stress ulcer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.4.1 If NSAIDs must be used postoperatively, combine with PPIs for stress ulcer prophylaxis.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4 General rehabilitation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4.1 Body temperature\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.1.1 It is recommended to monitor core body temperature during surgery and employ a warming and insulation system.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4.2 Skin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.2.1 Preoperative pressure ulcer risk assessment is recommended.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.2.2 It is recommended to select an appropriate surgical table and mattress to prevent intraoperative pressure ulcers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery low\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: obstructive sleep apnea, OSA; proton pump inhibitors, PPIs; gastroesophageal reflux disease, GERD; metabolic dysfunction-associated steatotic liver disease, MASLD; alanine aminotransferase, ALT; percentage of excess weight loss, %EWL; percentage of total weight loss, %TWL; postoperative nausea and vomiting, PONV; venous thromboembolism, VTE; hormone replacement therapy, HRT; nonsteroidal anti-inflammatory drugs, NSAIDs; IQR, interquartile range; coefficient of variation, CV.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOver 50% of recommendations are supported by Low or Very Low evidence levels, yet 70% carry strong recommendations, indicating reliance on expert consensus despite limited evidence. Median ratings for all recommendations are uniformly 5, with \u0026ge;\u0026thinsp;87% of ratings scoring 4 or 5, reflecting strong expert alignment. Higher coefficient of variation values (15\u0026ndash;25%) correlate with weaker recommendations (e.g., urate-lowering therapy, exercise regimens), suggesting less uniformity in expert opinions. Weak recommendations (30% of total) often align with lower evidence quality and higher CV values, highlighting areas needing further research.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003ePerioperative management of patients undergoing bariatric surgery necessitates a comprehensive multidisciplinary approach to address the complex interactions between obesity-related comorbidities, altered physiological adaptations, and inherent surgical risks. This consensus statement outlines essential strategies for optimizing rehabilitation nursing management with particular emphasis on integrating evidence-based clinical pathways and fostering multidisciplinary team (MDT) collaboration.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Disease-Specific Rehabilitation\u003c/h2\u003e\u003cp\u003e\u003cb\u003eRespiratory System\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRespiratory complications, particularly obstructive sleep apnea (OSA), represent a significant perioperative risk in bariatric populations. The utilization of validated screening tools such as the STOP-Bang and Berlin questionnaires ensures early identification of OSA, with polysomnography confirmation guiding severity stratification and therapeutic interventions \u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Preoperative continuous positive airway pressure (CPAP) not only mitigates perioperative hypoxia but also reduces postoperative cardiopulmonary complications, particularly in patients with moderate-to-severe OSA \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The emphasis on smoking cessation, respiratory rehabilitation exercises, and patient education aligns with evidence demonstrating improved pulmonary function and reduced postoperative morbidity \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIntraoperative adherence to airway management guidelines, including semi-upright positioning and prolonged intubation monitoring in high-risk cases, further minimizes respiratory compromise \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe patient's posture during the postoperative period should be either head-up or semi-recumbent \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. For patients exhibiting combined respiratory failure and hypoxemia, the administration of high-flow nasal cannula is an option to be considered, and the patient can be assisted with exercises such as effective coughing and deep breathing, in addition to the use of respiratory trainers to exercise lung function\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. For patients diagnosed with OSA who are routinely or temporarily treated with CPAP preoperatively, CPAP can be continued postoperatively or even 3\u0026ndash;6 months after discharge, and the duration of treatment can be determined based on the results of the polysomnography evaluation\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLong-term follow-up ensures sustained management of respiratory system diseases, reflecting the dynamic nature of weight loss on respiratory pathophysiology.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEndocrine System\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEndocrine system disorders, notably diabetes, require meticulous preoperative optimization and postoperative surveillance \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Female patients should be aware of the status of their menstrual cycles over the past 12 months, and female patients of childbearing age should be counseled to take the necessary contraceptive measures prior to the surgery \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The prevailing opinion suggests that preoperative blood glucose levels should not be mandated as an absolute prerequisite for performing bariatric surgery \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. However, it remains advisable to collaborate with endocrinologists in developing personalized glycemic control regimens preoperatively, supplemented by continuous glucose monitoring devices for real-time glucose tracking \u003csup\u003e[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Patients are advised to discontinue existing hypoglycemic agents preoperatively to facilitate medical transition to short-acting insulin therapy under clinical supervision \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Postoperative blood glucose management should target 7.8\u0026ndash;10.0 mmol/L as the target control range \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. For hospitalized patients exceeding this glycemic threshold, short-term intravenous insulin therapy should be prioritized. Post-discharge care requires intensified blood glucose monitoring with periodic follow-up assessments, followed by long-term surveillance to evaluate progression of diabetes-related complications \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHyperuricemia management, through urate-lowering therapy and hydration protocols, addresses the dual challenges of acute gout flares and long-term metabolic adaptations post-surgery \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. To effectively manage hyperuricemia and gout exacerbation preoperatively, alcohol abstinence is mandatory prior to hospitalization. Bariatric surgery exerts significant impacts on hyperuricemia and gout, necessitating comprehensive patient education postoperatively, including perioperative hydration maintenance, early physical rehabilitation, and minimization of diuretic use \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Regular monitoring of serum uric acid levels and assessment of gout-related symptoms should be performed postoperatively.\u003c/p\u003e\u003cp\u003eFor reproductive-aged women, particularly those with polycystic ovary syndrome, postoperative hormonal reassessment and contraceptive counseling are critical, given the rapid metabolic changes influencing fertility and menstrual regularity \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCirculatory System\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCardiovascular risk stratification, incorporating functional capacity assessments, ensures safe surgical candidacy \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Cardiac function can be assessed in a variety of ways, including cardiac function classification (e.g., NYHA classification, Killip classification, Forrest classification), left ventricular ejection fraction, noninvasive cardiopulmonary exercise test, 6-minute walk test, and modified cardiac risk assessment index \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The assessment of activity endurance should be evaluated to determine whether it meets or exceeds 4 metabolic equivalents. In cases where activity endurance is \u0026lt;\u0026thinsp;4 metabolic equivalents or presenting with cardiovascular risk factors, further assessment of cardiac function is necessary \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. If deemed necessary, pharmacologic or exercise stress testing is performed to evaluate myocardial ischemia \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBridging anticoagulation protocols for patients on antiplatelet therapy and hemodynamic optimization in hypertension or heart failure mitigate perioperative thromboembolic and ischemic events \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePostoperative monitoring of hemodynamic parameters in high-risk patients, coupled with graded mobilization to prevent orthostatic hypotension, reflects a proactive approach to cardiovascular stability. Patients suffering from severe obesity in combination with heart disease face an elevated risk of developing postoperative cardiovascular complications. It is therefore recommended that continuous postoperative monitoring of electrocardiogram, blood pressure, heart rate, and peripheral oxygen saturation is conducted for a period of more than 24 hours \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLong-term follow-up evaluations at standardized intervals enable early detection of weight loss-associated cardiac remodeling or residual cardiovascular dysfunction, facilitating timely intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDigestive System\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePreoperative screening for gastroesophageal reflux disease (GERD), \u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e), and metabolic dysfunction-associated steatotic liver disease (MASLD) informs surgical technique selection and prophylactic measures. Smoking and alcohol cessation are required preoperatively, with a minimum abstinence period of 2\u0026ndash;4 weeks for alcohol \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. In patients with alcoholism, strict abstinence from alcohol for 1\u0026ndash;2 years has been shown to reduce the risks associated with surgery \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In MASLD, serial monitoring of alanine aminotransferase (ALT) and lipid profiles is critical, with ALT reduction\u0026thinsp;\u0026ge;\u0026thinsp;17 U/L indicating histologic improvement \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. The emphasis on alcohol abstinence and dietary modifications preoperatively, combined with serial liver function monitoring postoperatively, underscores the bidirectional relationship between bariatric surgery and hepatic metabolic health. In addition, patients suffering from comorbidities such as GERD or cholelithiasis are advised to avoid foods that may trigger symptoms and are instructed to adhere to a low-fat, low-calorie diet, with meals consumed at regular intervals and in measured quantities, in order to prevent the recurrence of episodes of the disease \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eUrsodeoxycholic acid administration post-surgery effectively reduces cholelithiasis incidence, while proton pump inhibitors (PPIs) and lifestyle modifications address GERD exacerbations \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Endoscopic surveillance in symptomatic patients ensures early detection of anastomotic complications or ulcerations, particularly in malabsorptive procedures \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychological Disorders\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe bidirectional impact of bariatric surgery on mental health necessitates rigorous preoperative psychological evaluation and postoperative support \u003csup\u003e[\u003cspan additionalcitationids=\"CR37 CR38 CR39 CR40 CR41 CR42 CR43\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Preoperative education and informational support are critical to enhance patient understanding, establish realistic expectations, and alleviate anxiety or fear regarding the procedure. Patients should be counseled on the psychological benefits of surgery while acknowledging its limitations in treating pre-existing mental health conditions.\u003c/p\u003e\u003cp\u003eCognitive-behavioral interventions preoperatively enhance surgical readiness, while long-term monitoring for psychiatric comorbidities (e.g., depression, substance abuse) addresses the paradox of improved metabolic health coexisting with psychological distress \u003csup\u003e[\u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Patients demonstrating poor adherence to treatment guidelines, maladaptive stress management, negative emotions, disordered eating patterns, weight regain, or severe psychiatric conditions (e.g., major depression, severe eating disorders, suicidal behaviour, or substance dependence) should be promptly referred to psychiatric care\u003csup\u003e[\u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. In patients requiring continued psychotropic medications postoperatively, case managers and clinicians must monitor for adverse metabolic effects, including hyperglycemia, dyslipidemia, and weight gain, which may counteract surgical outcomes. Regular assessment of drug efficacy and side effects is essential to balance mental health management with metabolic preservation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Physiological Functional Rehabilitation\u003c/h2\u003e\u003cp\u003e\u003cb\u003ePhysical and Functional Exercise\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePreoperative exercise programs targeting aerobic capacity and musculoskeletal strength reduce surgical complications and enhance postoperative recovery \u003csup\u003e[\u003cspan additionalcitationids=\"CR50 CR51\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. The phased postoperative rehabilitation protocol, progressing from early ambulation to resistance training, prioritizes functional independence while mitigating muscle atrophy \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54 CR55 CR56\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e. The integration of validated assessment tools (e.g., Borg scale, Berg Balance Scale) ensures objective monitoring of rehabilitation efficacy \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e. However, challenges persist in maintaining long-term exercise adherence, necessitating individualized strategies that address motivational barriers and physical limitations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiet and Nutrition\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA personalised diet plan should be developed in consultation with a dietician, emphasising a high-protein, low-calorie, low-sugar, low-fat diet, limiting carbohydrates, supplementing vitamins and micronutrients, and maintaining adequate hydration \u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. Preoperative implementation of a low-calorie diet (1000\u0026ndash;1200 kcal/day) or very low-calorie diet (400\u0026ndash;800 kcal/day) may improve metabolic parameters such as blood glucose and lipid levels, facilitating effective weight control \u003csup\u003e[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e. Although studies suggest that preoperative intake of carbohydrate-rich beverages up to 2 hours before surgery enhances recovery and reduces hospitalization time without increasing postoperative complications, this practice remains controversial in domestic clinical settings\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePostoperatively, early oral feeding is encouraged to shorten fasting duration, with a recommended daily fluid intake of \u0026ge;\u0026thinsp;1500 ml\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e. Dietary progression should follow a structured transition from clear liquids to semi-liquid, soft, and finally solid food. During the initial three postoperative months, supplemental administration of whey protein powder is advised to optimize protein adequacy. Concurrently, comprehensive micronutrient supplementation is mandatory, including full-spectrum multivitamins and essential trace mineral formulations (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e. Rapidly absorbed carbohydrates and prolonged fasting should be avoided to prevent late dumping syndrome\u003csup\u003e[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVitamin and mineral supplementation after bariatric surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin and mineral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupplementation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin B1 \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;12 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin B12 \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e350\u0026ndash;500 \u0026micro;g/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin D \u003csup\u003e[\u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3000 U/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin A \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5000\u0026ndash;10000 U/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin E \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin K \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u0026ndash;120 \u0026micro;g/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalcium \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1200\u0026ndash;1500 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFolic acid \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e400\u0026ndash;800 \u0026micro;g/day\u003c/p\u003e\u003cp\u003e800\u0026ndash;1000 \u0026micro;g/day for pregnant women\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIron \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 mg/day for low risk patients\u003c/p\u003e\u003cp\u003e45\u0026ndash;60 mg/day for high risk patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZinc \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSG: 8\u0026ndash;11 mg/day\u003c/p\u003e\u003cp\u003eRYGB: 8\u0026thinsp;~\u0026thinsp;22 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCopper \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSG: 1 mg/day\u003c/p\u003e\u003cp\u003eRYGB: 2 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor patients with hyperuricemia or gout, collaborative management with a nutritionist is recommended to implement controlled protein intake, with specific restrictions on red meat, animal offal, seafood, and legumes, alongside increased fluid intake to promote uric acid excretion\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePostoperative care should incorporate structured patient education regarding the modest elevation in alcohol misuse risk associated with metabolic adaptations, emphasizing alcohol abstinence \u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e. Additionally, patients require guidance on potential medication adherence challenges and strategies to accommodate surgically induced alterations in dietary patterns \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLong-term surveillance for deficiencies (e.g., iron, vitamin B12, calcium) is critical, particularly in malabsorptive procedures, necessitating lifelong supplementation and dietary counseling \u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan additionalcitationids=\"CR72\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePreoperative weight loss therapy for high-risk patients (including those with super obesity, diabetes, cardiopulmonary dysfunction and other comorbidities) is recommended, targeting a 5%-10% reduction in body mass to optimize surgical outcomes, which may reduce liver volume, shorten operative duration, lower postoperative complication rates, and decrease 30-day mortality \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e. Long-term postoperative surveillance and continuous patient education is critical to evaluate sustained weight loss and prevent weight regain \u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/sup\u003e. The percentage of excess weight loss (%EWL) and total weight loss (%TWL) serve as validated metrics for assessing therapeutic efficacy during follow-up \u003csup\u003e[\u003cspan additionalcitationids=\"CR75\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFactors influencing postoperative weight loss, including hormonal profiles, psychological status, dietary patterns, adherence, and eating behaviors, should be systematically evaluated. For patients experiencing suboptimal weight loss or weight regain, targeted interventions (e.g., dietary modification, exercise regimens, and behavioral therapy) should be implemented \u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/sup\u003e. In cases of inadequate metabolic improvement or significant weight regain, MDT evaluation is recommended to determine the appropriateness of adjunctive pharmacotherapy (e.g., semaglutide or liraglutide) or revisional surgery \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Adverse Reaction Rehabilitation\u003c/h2\u003e\u003cp\u003e\u003cb\u003ePain and postoperative nausea and vomiting (PONV)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMultimodal analgesia, minimizing opioid use through regional blocks and non-steroidal anti-inflammatory drugs (NSAIDs), addresses the dual challenges of effective pain control and reduced emetogenic risk \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e. The 19.5% incidence of PONV mandates risk stratification (e.g., Apfel score) and prophylactic antiemetics, particularly in high-risk cohorts \u003csup\u003e[\u003cspan additionalcitationids=\"CR84 CR85\" citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]\u003c/sup\u003e. Refractory cases require exclusion of mechanical obstructions, highlighting the importance of vigilant postoperative monitoring \u003csup\u003e[\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eVenous Thromboembolism (VTE)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCombined mechanical and pharmacological prophylaxis, guided by preoperative risk assessment, reduces the VTE incidence in bariatric surgery \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e. Patients should consider discontinuing estrogen-containing oral contraceptives for 1 month and hormone replacement therapy (HRT) for 3 weeks preoperatively to reduce the risk of VTE \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. VTE risk should be re-assessed within 6 hours post-surgery and functional mobility training should be performed. Patient education on early mobilization and compression stocking therapy fosters adherence to preventive measures \u003csup\u003e[\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eExtended post-discharge anticoagulation in high-risk patients, coupled with D-dimer surveillance, balances thrombotic and hemorrhagic risks \u003csup\u003e[\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStress Ulcers\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePPIs prophylaxis has been demonstrated to reduce the risk of ulceration, particularly in patients with preoperative GERD or who have been prescribed NSAIDs \u003csup\u003e[\u003cspan additionalcitationids=\"CR92\" citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e. Postoperative dietary modifications and avoidance of gastric irritants synergize with pharmacotherapy to protect mucosal integrity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e4.4 General Rehabilitation\u003c/h2\u003e\u003cp\u003eThermoregulatory management, through preoperative warming and intraoperative fluid heating, prevents hypothermia-related complications \u003csup\u003e[\u003cspan additionalcitationids=\"CR95 CR96 CR97 CR98\" citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e]\u003c/sup\u003e. Skin care protocols, addressing pressure ulcer risks intraoperatively and excess skin management postoperatively, enhance patient comfort and reduce infection risks \u003csup\u003e[\u003cspan additionalcitationids=\"CR101 CR102\" citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e]\u003c/sup\u003e. Reconstructive surgery, deferred until weight stabilization, improves psychosocial outcomes in patients with significant skin laxity \u003csup\u003e[\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Limitation\u003c/h2\u003e\u003cp\u003eThis consensus has several limitations. First, the expert panel predominantly comprised professionals from major hospitals, potentially underrepresenting primary care perspectives. Regional disparities and variations in healthcare resources may limit the generalizability of recommendations. Second, over 50% of statements were supported by low or very low evidence, reflecting reliance on expert opinion rather than robust clinical data. Third, the study lacks long-term follow-up data to validate the sustainability of proposed interventions, particularly regarding weight maintenance and psychological outcomes. Additionally, cultural and socioeconomic factors influencing patient adherence (e.g., dietary habits, access to rehabilitation services) were not thoroughly explored. Finally, the consensus process did not incorporate patient perspectives, potentially overlooking experiential insights critical to patient-centered care. Future efforts should aim for broader stakeholder inclusion, higher-quality evidence generation, and pragmatic strategies to overcome systemic and contextual challenges in diverse healthcare settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis consensus establishes a framework for comprehensive rehabilitation nursing management in China, emphasizing integrated perioperative care. Through a Delphi-based process, consensus was formulated across disease-specific rehabilitation, physiological function, adverse reactions, and general rehabilitation. The consensus advocates expanding case manager roles and integrating primary care. Future efforts should focus on establishing evidence-based guidelines, national certification systems, and scalable care models to ensure equitable, sustainable outcomes in China\u0026rsquo;s growing bariatric population. This establishes a foundation for advancing evidence-based guidelines, national certification programs, and scalable care models.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ealanine aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econtinuous positive airway pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGERD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003egastroesophageal reflux disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehormone replacement therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMASLD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emetabolic dysfunction-associated steatotic liver disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMDT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emultidisciplinary team\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNSAIDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003enon-steroidal anti-inflammatory drugs\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eobstructive sleep apnea\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePONV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epostoperative nausea and vomiting\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePPIs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eproton pump inhibitors\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVTE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003evenous thromboembolism\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e%EWL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epercentage of excess weight loss\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e%TWL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epercentage total weight loss\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThe study is retrospectively registered at National Institute for Health and Care Research (1084722). This research was approved by the Ethics Committee of the Fourth Affiliated Hospital of China Medical University (EC-2025-KS-116). A written informed consent is obtained from all participants before inclusion in the study. All participants are informed that they can withdraw from the study at any time without giving a reason.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLRK: writing the original draft, analysis of data, methodology. DX: analysis of data, methodology. YYY: analysis of data, methodology. YSY: analysis of data, methodology. MYS: review and editing of final draft. XMC: project administration, editing the final draft. LLS: project administration, editing the final draft. YW: project administration, editing the final draft. HYX: project administration, editing the final draft. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to extend our sincere gratitude to Ningli Yang, Lilian Gao, Lin Yao, Ronghui Du, Yanmin Du, Yue Wen, Xia Zhang, Dafang Zhan, Yunqing Li, Rongyuan Jiang, Qiyun Chen, Meng Zhang, Haiying Li, Jiarui Li, and Yuanmin Gao for their professional guidance and technical support throughout this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBerger NK, Carr JJ, Erickson J, Gourash WF, Muenzen P, Smolenak L, et al. Path to bariatric nurse certification: the practice analysis. 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J Plast Surg Hand Surg. 2013;47(1):50\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/2000656x.2012.731001\u003c/span\u003e\u003cspan address=\"10.3109/2000656x.2012.731001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"bariatric surgery, rehabilitation, perioperative management, consensus, nursing","lastPublishedDoi":"10.21203/rs.3.rs-7033052/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7033052/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBariatric surgery is an effective treatment for obesity and metabolic disorders, yet sustainable outcomes require comprehensive perioperative strategies. In China, the emerging role of case manager in multidisciplinary teams remains underdeveloped, with inconsistent competencies and limited primary care integration. This study aimed to establish a national expert consensus to optimize rehabilitation nursing management for bariatric surgery patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA modified Delphi protocol was employed. The consensus-building process included two questionnaire rounds, quantitative evaluation via a 5-point Likert scale, and qualitative feedback. Recommendations were developed across preoperative, intraoperative, and postoperative phases, supported by literature reviews and evidence grading. Data were analyzed using SPSS 27.0, with consensus defined as \u0026ge;\u0026thinsp;80% agreement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e54 multidisciplinary healthcare experts from 22 provinces nationwide were recruited. 52 recommendations were finalized, categorized into disease-specific rehabilitation, physiological function, adverse reactions, and general rehabilitation. Median ratings for all recommendations are uniformly 5, with \u0026ge;\u0026thinsp;87% of ratings scoring 4 or 5, reflecting strong expert alignment. Weak recommendations (30% of total) often align with lower evidence quality and higher coefficient of variation values, highlighting areas needing further research.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis consensus provides a structured framework for multidisciplinary rehabilitation nursing in bariatric care, emphasizing case manager integration and evidence-based pathways. While addressing critical perioperative challenges, limitations include major hospital bias and reliance on expert opinion. Future priorities include national certification systems, scalable care models, and long-term outcome validation to enhance equitable patient management in China\u0026rsquo;s growing bariatric population.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eThe study is retrospectively registered at National Institute for Health and Care Research (1084722).\u003c/p\u003e","manuscriptTitle":"Comprehensive Rehabilitation Nursing Management of Bariatric Surgery: Chinese Expert Consensus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:02:28","doi":"10.21203/rs.3.rs-7033052/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7a86900-a962-4b94-ae97-2a6d3a201ef6","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-13T08:09:58+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T08:31:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:02:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7033052","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7033052","identity":"rs-7033052","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}