Hutter Matthew M, Jones Daniel B, M Riley Stancel, Snow Roger L, Cella Robert J, Schneider Benjamin E, A Clancy Kerri
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Obesity (Silver Spring). 2009 May;17(5):924-8. doi: 10.1038/oby.2008.568. Epub 2009 Feb 19.
To update evidence-based best practice guidelines for collection of data on weight loss surgery (WLS). Systematic search of English-language literature in MEDLINE and the Cochrane Library on WLS and data collection, registries, risk adjustment, accreditation, benchmarks, and administrative and outcomes databases published 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. During our search, we identified 212 papers; the 63 most relevant were reviewed in detail. Most data collection on WLS has relied on administrative data sets, single-institution studies, and other sources that are not WLS specific. A six-center, nationwide study involving data collection has been started by the longitudinal assessment of bariatric surgery, but results are not yet available. Two WLS-specific, longitudinal, national data collection systems are about to be implemented. Key factors in patient safety include data collection for all weight loss procedures; prospective, risk-adjusted, universal, benchmarked, longitudinal data collection systems; and use of WLS-specific data points that track clinical effectiveness and complications following WLS. Data collection will need to include assessments of novel therapies and specific subgroups (e.g., adolescents, the elderly, and individuals who are at the greatest risk or have the most to gain from WLS). Quality indicators, including metrics on processes of care and determination of outliers, need to be established and monitored to advance patient safety and quality improvement.
更新关于减肥手术(WLS)数据收集的循证最佳实践指南。在MEDLINE和Cochrane图书馆中系统检索2004年4月至2007年5月期间发表的关于WLS及数据收集、登记处、风险调整、认证、基准以及行政和结局数据库的英文文献。使用关键词缩小检索范围以对摘要进行选择性综述、检索全文,并根据既定循证模型中使用的系统对证据进行分级。在检索过程中,我们识别出212篇论文;对其中63篇最相关的论文进行了详细综述。大多数关于WLS的数据收集依赖于行政数据集、单机构研究以及其他非WLS特定的来源。一项由减肥手术纵向评估发起的涉及数据收集的六中心全国性研究已经启动,但结果尚未可得。两个特定于WLS的纵向全国数据收集系统即将实施。患者安全的关键因素包括对所有减肥手术的数据收集;前瞻性、风险调整、通用、基准化的纵向数据收集系统;以及使用特定于WLS的数据点来追踪WLS后的临床疗效和并发症。数据收集将需要包括对新疗法和特定亚组(例如青少年、老年人以及从WLS中获益最大或风险最高的个体)的评估。需要建立并监测质量指标,包括护理过程的指标和异常值的判定,以促进患者安全和质量改进。