Appropriateness Criteria for Bariatric Surgery: Beyond the NIH Guidelines
Appropriateness Criteria for Bariatric Surgery: Beyond the NIH Guidelines
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DOI：
10.1038/oby.2009.78
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发表时间：
2009-08-01
期刊：
影响因子：
6.9
通讯作者：
Maggard, Melinda A.
中科院分区：
文献类型：
--
作者：
Yermilov, Irina;McGory, Marcia L.;Maggard, Melinda A.
仔细选择肥胖患者是取得成功的关键。1991年，美国国立卫生研究院首次制定了患者选择指南；然而，一些外科医生在这些标准之外为个人进行手术，即极端年龄段。我们制定了适合患者特征的标准，包括年龄、BMI和八种与肥胖相关的合并症的严重程度。候选标准使用患者特征的组合，包括BMI：=40 kg/m(2)、35-39、32-34、30-31、=40 kg/m(2)或BMI=35-39 kg/m(2)被发现适合手术。相比之下，极端年龄组的患者在较少的情况下被认为是合适的手术对象，主要是更严重的合并症，如糖尿病和高血压。对于体重指数在32-34之间的患者，只有最严重的糖尿病类别(Hgb A1c和Gt；9，关于最大限度的药物治疗)是适合19岁-的患者的标准，而许多轻到中度的合并疾病类别是“不合适的”。小组成员一致认为，目前的证据不支持在较低BMI个体(BMI)中进行减肥手术
Careful selection of bariatric patients is critical for successful outcomes. In 1991, the NIH first established patient selection guidelines; however, some surgeons operate on individuals outside of these criteria, i.e., extreme age groups. We developed appropriateness criteria for the spectrum of patient characteristics including age, BMI, and severity of eight obesity-related comorbidities. Candidate criteria were developed using combinations of patient characteristics including BMI: >= 40 kg/m(2), 35-39, 32-34, 30-31, = 40 kg/m(2) or BMI = 35-39 kg/m(2) in intermediate age groups were found to be appropriate for surgery. In contrast, patients in the extreme age categories were considered appropriate surgical candidates under fewer conditions, primarily the more severe comorbidities, such as diabetes and hypertension. For patients with a BMI of 32-34, only the most severe category of diabetes (Hgb A1c >9, on maximal medical therapy), is an appropriate criterion for those aged 19-64, whereas many mild to moderate severity comorbidity categories are "inappropriate." There is overwhelming agreement among the panelists that the current evidence does not support performing bariatric surgery in lower BMI individuals (BMI