Mapping the Landscape of Perioperative Management in Metabolic and Bariatric Surgery: A Value-Complexity...

To systematically map the intellectual landscape of perioperative management in metabolic and bariatric surgery (MBS) and classify research themes using a quantified Value-Complexity framework, thereby identifying priority areas for future investigation.

A total of 939 articles on MBS perioperative management were retrieved from the Web of Science Core Collection (2000-2026). After screening, 817 publications were included. CiteSpace 6.4.R1 was employed for co-authorship, co-citation, and keyword analyses. Three independent raters evaluated each research cluster across six quantified dimensions: clinical impact, evidence maturity, generalizability (value), resource requirements, technical difficulty, and organizational coordination (complexity). Inter-rater reliability was excellent (ICC = 0.86 for value, 0.82 for complexity). Clusters were classified into four strategic quadrants-Star, Cornerstone, Trap, and Niche-based on predefined thresholds (≥ 7 for "high" on each dimension).

The field has evolved through three phases: technology exploration (2000-2008), evidence standardization (2009-2015), and system integration (2016-2024). The United States (351 articles, centrality 0.37) and Harvard University (49 articles) dominate scholarly output. Keyword bursts reveal a shift from surgical technique toward enhanced recovery (burst strength 9.38, 2019-2023) and multidisciplinary care. Among seven identified clusters, five were classified as Cornerstone (high value, low complexity): enhanced recovery (#1), clinical practice guidelines (#5), and others. Two clusters-randomized clinical trials (#4) and long-term weight-loss patient management (#6)-emerged as Star domains (high value, high complexity), representing strategic priorities. No clusters fell into Trap or Niche quadrants.

Integrating bibliometric mapping with a quantified Value-Complexity framework offers a novel approach to research prioritization in MBS perioperative management. While foundational practices are mature, future efforts should prioritize high-value, high-complexity domains. This framework may apply to other surgical specialties for strategic research planning.