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We assessed whether routine preoperative urine toxicology screening tests (TSTs) predict anesthetic requirements, recovery, early complications, and 1-year weight loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective single-center cohort of 1,260 primary MBS patients (Alexandria, Egypt; Dec 2023\u2013May 2024). All underwent urine screening for seven substance classes and were classified as TST-positive or TST-negative. Outcomes included propofol and intraoperative fentanyl doses, recovery metrics, postoperative pain (VAS) and opioid requirements, 30-day complications\/readmissions, length of stay, and 1-year percent total and excess weight loss (%TWL, %EWL). Inverse propensity score weighting (IPSW) balanced baseline covariates. One-year outcomes were available for 1,134 of 1,260 patients (90.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      190 out of 1,260 (15.1%) were TST-positive\u2014most commonly tramadol (57.9%) and cannabis (36.8%); 12.1% denied use despite a positive TST. After IPSW adjustment, TST-positive patients required more propofol (mean difference 49.7\u00a0mg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and fentanyl (MD 51.2\u00a0\u00b5g;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), experienced longer recovery times (MD 5.36\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), had higher postoperative VAS scores and opioid requirements, longer hospital stays (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and increased 30-day complications (5.4% vs. 1.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) and readmissions (7.1% vs. 1.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Routine preoperative TST identifies patients at risk for increased anesthetic\/analgesic needs, delayed recovery, agitation, and higher early morbidity. Incorporating TST into preoperative pathways may optimize perioperative planning in MENA settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>NCT07100314.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-026-08534-3","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:25:55Z","timestamp":1774963555000},"page":"2132-2149","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Preoperative Toxicological Screening on Perioperative Anesthetic Management and Short-Term Outcomes Following Metabolic and Bariatric Surgery: A Prospective Observational Study"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6650-8112","authenticated-orcid":false,"given":"Mohamed","family":"Hany","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-2549","authenticated-orcid":false,"given":"Adel Ibrahim","family":"Hozien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba Abdel Samie","family":"Mohamed Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Islam","family":"El-Sayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engi Yousry","family":"Hashem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9497-8159","authenticated-orcid":false,"given":"Ehab","family":"Elmongui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-9969","authenticated-orcid":false,"given":"Ahmed","family":"El Shamarka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0961-1302","authenticated-orcid":false,"given":"Walid","family":"El Ansari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"issue":"10481","key":"8534_CR1","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","volume":"405","author":"GBDAB Collaborators","year":"2025","unstructured":"Collaborators GBDAB. 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