Machine Learning and Large Language Models in Preoperative Bariatric Surgery: From Risk Assessment to Shared Decision-Making

Recent increases in overweight and obesity have established Metabolic–Bariatric Surgery (MBS) as a principal intervention for durable weight reduction and metabolic improvement. Given the elevated perioperative complication risk among patients with obesity, there is a growing imperative to enhance the precision of preoperative management. This review synthesizes evidence from 2020–2025 on the application of artificial intelligence (AI) to bariatric surgery preoperative assessment, focusing on machine learning (ML), deep learning (DL), and large language models (LLMs). We summarize AI applications across three domains: preoperative risk prediction and individual assessment, patient stratification and procedure selection, and preoperative education and surgical training. The evidence suggests that integrating AI into routine preoperative workflows enables individualized, quantitative estimation of high-risk complications and weight-loss prognosis, thereby optimizing risk management; it can also support patient stratification and procedure matching to facilitate patient-centered shared decision-making; and NLP- and vision-based tools promote standardization and visualization of knowledge for patients and surgeons. Overall, AI is driving preoperative assessment toward greater individualization, interpretability, and multidisciplinary coordination, but its clinical generalizability requires validation in multicenter, prospective studies.