Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Int J Obes (Lond). 2012 Nov;36(11):1380-7. doi: 10.1038/ijo.2012.60. Epub 2012 Apr 17.
Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies>20 years old and studies that utilized self-reported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.
术前减重要求因外科医生和外科中心而异，实践标准尚未确立。本系统评价的目的是总结和评估有关术前减重要求和术前减重与术后结果之间关系的现有文献。主要数据库，包括 Medline、PubMed 和 PsychINFO，都被用来搜索相关文章。排除了病例研究、超过 20 年的研究以及使用自我报告体重数据的研究。总结了以下内容的影响数据：（1）术前要求对术前体重减轻的影响；（2）保险要求的术前要求；（3）手术的接受情况；（4）术前体重减轻对术后体重减轻的影响；（5）术前体重减轻对围手术期和术后并发症和合并症发生率的影响。大多数研究表明：（1）美国大多数第三方支付机构目前的术前要求在促进术前体重减轻方面效果不佳；（2）使手术的接受取决于达到术前体重减轻和代餐饮食可能特别有效地促进术前体重减轻；（3）术前体重减轻可能会导致至少一些相关的术后结果得到改善。然而，术前减重要求可能会导致那些无法达到规定体重的个人被拒绝手术和随后的健康益处。总体而言，该领域有限数量和质量的前瞻性研究禁止为术前要求制定急需的实践标准。
