Expert Panel on Weight Loss Surgery: Executive Report Update (original) (raw)
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Best Practice Updates for Multidisciplinary Care in Weight Loss Surgery
Obesity, 2009
The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence-based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New recommendations were developed in the areas of patient selection, medical evaluation, and treatment. Regular updates of evidence-based recommendations for best practices in multidisciplinary care are required to address changes in patient demographics and levels of obesity. Key factors in patient safety include comprehensive preoperative medical evaluation, patient education, appropriate perioperative care, and long-term follow-up. selection, and enables patients to choose the surgical procedure most appropriate for them, thus, leading to more successful outcomes. Registered dietitians can help patients make informed decisions (9).
Best Practice Updates for Surgical Care in Weight Loss Surgery
Obesity, 2009
To update evidence-based best practice guidelines for surgical care in weight loss surgery (WLS). Systematic search of English-language literature on WLS in MEDLINE, EMBASE, and the Cochrane Library between April 2004 and May 2007. Use of key words to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. Evidence-based best practice recommendations from the most recent literature on surgical methods and technologies, risks and benefits, outcomes, and surgeon qualifications and credentialing. We identified >135 articles; the 65 most relevant were reviewed in detail. Regular updates of evidence-based recommendations for best practices in WLS are required to address rapid changes in surgical techniques and patient demographics. Key factors in patient safety include surgical risk factors, type of procedure, surgeon training, and facility certification.
Surgery for Morbid Obesity: Selection of Operation Based on Evidence from Literature Review
Obesity Surgery, 2005
This review assessed the effects of bariatric surgery for morbid obesity. The authors concluded that the methodological quality of primary studies up to 2002 has been poor. The authors' conclusions are appropriate and warranted given the evidence reviewed. Authors' objectives To assess the effects of bariatric surgery for morbid obesity on excess weight loss, surgical failure and reduction of comorbidities. Searching MEDLINE, LILACS and the Cochrane Library were searched from January 1990 to December 2002; the search terms were reported. Studies were restricted to those published in Spanish, English, French or Italian. Study selection Study designs of evaluations included in the review Studies of all designs were eligible for inclusion. Review and discussion articles, letters to the editor and clinical guidelines were excluded. Specific interventions included in the review Studies that assessed vertical or horizontal gastroplasty, adjusted or non-adjusted gastric banding, gastric bypass, open surgery or laparoscopy were eligible for inclusion. The included studies used laparoscopic and open banding, gastroplasty, gastric bypass and biliopancreatic diversion. Participants included in the review Studies that included patients aged older than 19 years with morbid obesity, defined as a body mass index (BMI) of at least 40 kg/m2 or a BMI greater than 35 kg/m2 with co-morbidity, and who had not undergone prior bariatric surgery, were eligible for inclusion. Outcomes assessed in the review Studies that assessed weight loss at 12, 24 and 36 months, reduction in co-morbidity, the percentage excess weight loss, operative complications, reoperations, hospital length of stay, follow-up, the percentages of successful and unsuccessful operations, and mortality associated with the operations, were eligible for inclusion. How were decisions on the relevance of primary studies made? The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality The validity of the primary studies was assessed using a scale that assesses study design, sample size and other methodological aspects. The final potential score for each study ranged from 6 to 36 points. Studies scoring 18 points or more were considered higher quality. The authors did not state how many reviewers performed the validity assessment. Data extraction The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.
Annals of Surgery, 2004
This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients. Background: Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown. Methods: We used an observational 2-cohort study. The treatment cohort (n ϭ 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n ϭ 5746) included age-and gendermatched severely obese patients who had not undergone weightreduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception. Results: The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P Ͻ 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%. Conclusions: This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.
Specialized Staff and Equipment for Weight Loss Surgery Patients: Best Practice Guidelines**
Obesity, 2005
To provide evidence-based guidelines on the specialized personnel, equipment, and physical plant required for safe and effective care of severely obese weight loss surgery (WLS) patients. We examined MEDLINE (Ovid and PubMed) and the Cumulative Index of Nursing and Allied Health Literature for articles on facilities resources for care of WLS patients published in English between January 1980 and March 2004. We queried several web sites for appropriate references; these included the Agency for Healthcare Research and Quality and the American College of Surgeons. The majority of reference material was descriptive and not specific to facilities resources for WLS patients. We identified a substantial body of literature on the general subject of patient safety; three of these articles were used to develop recommendations on the use of technology for medical error reduction. All other recommendations are based on 11 expert opinion reports. We recommended adequate training and credentialing for all medical staff; dedicated support and administrative personnel; and specialized interventional, diagnostic, operating room, and transport equipment. We specified needed adaptations to the physical plant and developed evidence-based guidelines for medical error reduction and systems improvements. Specialized resources and dedicated staff are needed to protect the health of WLS surgery patients and staff. Adaptations include preoperative preparation for safe means of patient transport; techniques of anesthesia and intraoperative exposure; provisions for postoperative recovery; and measures to assure postoperative patient safety, hygiene, and comfort.
Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients
Annals of Surgery, 2004
This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients. Background: Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown. Methods: We used an observational 2-cohort study. The treatment cohort (n ϭ 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n ϭ 5746) included age-and gendermatched severely obese patients who had not undergone weightreduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception. Results: The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P Ͻ 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%. Conclusions: This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.
Best Practice Updates for Informed Consent and Patient Education in Weight Loss Surgery
Obesity, 2009
nature publishing group articles intervention and Prevention IntroductIon Evidence-based best practice guidelines for informed consent in weight loss surgery (WLS) have been previously described (1). Previous recommendations focused on understanding vs. disclosure, appropriate content, teaching and learning, and promoting realistic expectations (1). The 2004 task group found no studies on informed consent and WLS. Recommendations were based on three review articles, standard practice at six WLS centers in Massachusetts, and the consensus of the expert panel (1). No studies on WLS and informed consent have been published since that time. Recommendations are, therefore, based on related articles identified through our search strategy. This report adds recommendations to those in the 2005 guidelines, and describes the supporting evidence. To make sound medical decisions, patients must not only receive adequate and appropriate information, but also understand it (2). Poor comprehension of the risks, benefits, and consequences of surgery can contribute to unrealistic expectations, suboptimal decision making, and potential litigation (3). The previous report cited a need for studies that assess the effect of different forms of education on patient understanding (1). This update draws on the evolving literature on patient safety and WLS outcomes to make recommendations on informed consent content. It also reviews the literature on patient comprehension in informed consent, including studies on health literacy and on clinical areas (e.g., cardiac surgery) that might apply to WLS. Methods and Procedures We searched MEDLINE and the Cochrane database for articles on bariatric or elective surgery and informed consent, comprehension, health literacy, and patient education published between April 2004 and May 2007. We also conducted searches on bariatric surgery and outcomes, risk, patient safety management, and effectiveness. In addition, we reviewed WLS guidelines and other potentially relevant articles recommended by the expert panel or cited in the initial articles we identified.