Section of Bariatric Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Surg Obes Relat Dis. 2011 Jul-Aug;7(4):526-30. doi: 10.1016/j.soard.2010.08.017. Epub 2010 Sep 19.
Insurance companies often require a mandated medical program (MMP) before bariatric surgery. It is unknown whether MMPs improve weight loss before and after surgery. The purpose of our study was to determine whether MMPs improve pre- and postoperative weight loss at a tertiary care, U.S. academic teaching hospital.
After institutional review board approval, data were collected prospectively from consecutive patients undergoing nonrevisional laparoscopic gastric bypass or adjustable gastric banding from August 2006 to 2010 by a single surgeon (T.S.K.). The patients were divided into 2 groups: those undergoing a MMP and those who did not. The MMP patients underwent a standardized program of ≥6 months' duration under the direction of our medical bariatricians and nutritionists. The data from the laparoscopic gastric bypass and laparoscopic adjustable gastric banding patients were analyzed separately. The primary outcome data included the interval to surgery and the percentage of excess weight loss before surgery and at 6 and 12 months after surgery.
A total of 440 patients (327 laparoscopic gastric bypass and 113 laparoscopic adjustable gastric banding) were included in the present study. No significant difference was found in the preoperative percentage of excess weight loss or the percentage of excess weight loss at 6 and 12 months after surgery between the MMP and non-MMP patients. The MMP patients had a significantly longer wait time to surgery.
Patients who underwent a standardized MMP had a significant delay in their time to surgery and did not experience significant benefit in their preoperative or postoperative weight loss. Insurance companies should abandon the policy of mandating preoperative medical weight loss programs.
保险公司通常要求在进行减肥手术前进行强制性医疗项目 (MMP)。目前尚不清楚 MMP 是否会改善手术前后的体重减轻情况。我们的研究目的是确定在美国一家三级保健、学术教学医院，MMP 是否会改善减肥手术前后的体重减轻情况。
在获得机构审查委员会批准后，我们连续前瞻性地收集了由同一位外科医生 (T.S.K.) 于 2006 年 8 月至 2010 年期间施行的非修正腹腔镜胃旁路手术或可调胃束带术的患者数据。将患者分为 2 组：接受 MMP 和未接受 MMP。MMP 患者在我们的减肥医学专家和营养师的指导下进行了至少 6 个月的标准化方案。对腹腔镜胃旁路手术和腹腔镜可调胃束带术患者的数据分别进行分析。主要结果数据包括手术前间隔时间、手术前和手术后 6 个月和 12 个月的超重体重百分比损失。
共有 440 例患者 (327 例腹腔镜胃旁路手术和 113 例腹腔镜可调胃束带术) 纳入本研究。在 MMP 和非 MMP 患者之间，手术前超重体重百分比损失或手术后 6 个月和 12 个月的超重体重百分比损失无显著差异。MMP 患者的手术等待时间明显更长。
接受标准化 MMP 的患者手术等待时间明显延长，且术前或术后体重减轻没有明显获益。保险公司应放弃强制术前医疗减肥方案的政策。
