Accepted for/Published in: JMIR Research Protocols
Date Submitted: Apr 21, 2026
Date Accepted: Aug 11, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Clinical, Economic and System-Level Outcomes of Bariatric Surgery in Adults: Protocol for a Systematic Review
ABSTRACT
Background:
Obesity affects over 650 million adults worldwide and carries substantial health, economic, and social consequences. Although bariatric surgery achieves sustained weight loss and metabolic improvement, existing systematic reviews largely predate 2020 and rarely integrate clinical, economic, and system-level perspectives simultaneously.
Objective:
To identify, critically appraise, and synthesise evidence published between 2020 and 2025 on the clinical effectiveness, economic impact, and system-level resource utilisation of bariatric surgery in adults with obesity. An exploratory objective addresses length of stay, preoperative pathway duration, and outpatient care burden.
Methods:
The protocol was developed following PRISMA-P 2015 guidelines and submitted for PROSPERO registration (CRD420261351022). Eligible studies will enrol adults aged ≥18 years with obesity (BMI ≥30 kg/m²) undergoing any primary bariatric procedure (including RYGB, SG, OAGB, LAGB, and BPD±DS). Comparators may include alternative procedures, non-surgical care, or none. Eligible designs include RCTs, cohort, case-control, cross-sectional, and economic evaluation studies published in English. MEDLINE/PubMed, Scopus, and Web of Science will be searched using pre-defined, database-tailored strategies; records managed in Zotero. Study selection and data extraction will be performed by a single reviewer with independent 10% verification. Risk of bias will be assessed using RoB 2.0, ROBINS-I, and CHEERS 2022 as appropriate. The primary synthesis approach is narrative; meta-analysis will be considered conditionally. Evidence certainty will be rated using GRADE.
Results:
This review will deliver an integrated, contemporary evidence base to inform health policy and resource planning for bariatric surgery programmes.
Conclusions:
This protocol provides a transparent and reproducible methodology for a systematic review of contemporary evidence on the clinical, economic, and system-level outcomes of bariatric surgery in adults. The findings are intended to inform health policy, resource planning, and future research priorities in bariatric surgery.
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