Abstract
<title>Abstract</title> <p>Background Associations among preoperative psychological evaluation (PPE) recommendations (no required follow-up [NFU] vs. require follow-up [RFU]), demographic and psychiatric diagnosis, preoperative program completion, time to metabolic bariatric surgery (MBS), and postoperative BMI were examined. Methods Archival data was retrieved for PPE recommendations and outcomes within an MBS program at a public hospital. Results 475 patients initiated a PPE for MBS (361 NFU, 114 RFU). RFU patients had lower education and employment rates, higher disability and psychiatric diagnosis prevalence, and lower rates of partnered status than NFU patients, though higher odds of completing surgery within 1 year of psychological clearance (OR = 3.18, p = 0.026). Postoperative BMI did not differ between groups. Unpartnered status or an alcohol use disorder diagnosis was associated with greater odds of preoperative discontinuation in both groups. Patients with ≥ 1 PPE no-show had 42% longer time from psychological clearance to surgery (GMR = 1.42, p = 0.008). Those requiring 2 sessions for psychological clearance had 14% shorter time to surgery than patients cleared in 1 session (GMR = 0.86, p = 0.040). Psychological clearance in 2025 associated with 21% shorter time to surgery than clearance in 2024 (GMR = 0.79, p < 0.001). Conclusion Significant demographic and psychiatric differences were observed between NFU and RFU patients. In both groups, patient factors identified at the PPE correlated with MBS completion and time to surgery, highlighting the role of the PPE as both a screening tool and intervention for modifiable barriers to surgical progression.</p>