Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.
Developmental Disabilities Institute, Wayne State University, Detroit, Michigan.
Surg Obes Relat Dis. 2017 Oct;13(10):1768-1779. doi: 10.1016/j.soard.2017.08.008. Epub 2017 Aug 12.
Bariatric surgery has been performed on adolescents since the 1970s, but little is known about the guidance offered to providers in recommendation documents published in the United States. A systematic review was conducted to generate a complete record of all US recommendation documents and describe variability across the documents. This study had 3 aims: to identify the developers, examine selection criteria, and document reasons why developers have recommended this intervention for adolescents. Four databases (MEDLINE, National Guidelines Clearinghouse, Trip, and Embase) ertr searched, followed by a hand search. Documents were eligible for inclusion if they satisfied 5 criteria: written in the English language; developed and published by a US organization; comprised a clinical practice guideline, position statement, or consensus statement; offered a minimum 1-sentence recommendation on bariatric surgery for the treatment of obesity or related co-morbidities; and offered a minimum 1-sentence recommendation on bariatric surgery for children, adolescents, or both. No date limits were applied. Sixteen recommendation documents published between 1991 and 2013 met our inclusion criteria: 10 clinical practice guidelines, 4 position statements, and 2 consensus statements. Nine were produced by medical organizations, 3 by surgical organizations, and 4 by public health/governmental bodies. One document recommended against bariatric surgery for minors, and 15 endorsed the intervention for this population. Body mass index (a measure of obesity calculated by dividing weight in kilograms by the square of height in meters) thresholds were the selection criteria most often provided. Minimum age varied widely. Of the 15 endorsing documents, 10 provided a reason for performing bariatric surgery on minors, most often to treat obesity-related co-morbidities that threaten the health of the adolescent. We make 3 suggestions to improve the quality of future recommendation documents.
自 20 世纪 70 年代以来，减重手术已经在青少年中开展，但在美国发布的推荐文件中，提供给提供者的指导信息却鲜为人知。本研究旨在对美国所有的推荐文件进行全面记录，并对文件之间的差异进行描述，为此进行了系统综述。该研究有 3 个目标：确定开发者、检查选择标准，并记录开发者推荐该干预措施用于青少年的原因。通过 MEDLINE、国家指南清理中心、Trip 和 Embase 这 4 个数据库进行了检索，然后进行了手工搜索。如果文件符合以下 5 个标准，则有资格被纳入：用英语书写；由美国组织开发和发布；包含临床实践指南、立场声明或共识声明；对肥胖或相关合并症的治疗提供了关于减重手术的至少 1 句推荐；对儿童和青少年或两者都提供了关于减重手术的至少 1 句推荐；没有设定日期限制。16 份推荐文件符合我们的纳入标准，这些文件发表于 1991 年至 2013 年之间，包括 10 份临床实践指南、4 份立场声明和 2 份共识声明。其中 9 份由医学组织制定，3 份由外科组织制定，4 份由公共卫生/政府机构制定。有 1 份文件建议反对未成年人进行减重手术，15 份文件赞成该干预措施适用于这一人群。体重指数（肥胖的一种衡量标准，通过体重除以身高的平方来计算）阈值是最常提供的选择标准。最低年龄差异很大。在 15 份支持性文件中，有 10 份提供了对未成年人进行减重手术的原因，最常见的原因是治疗威胁青少年健康的肥胖相关合并症。我们提出了 3 条建议，以提高未来推荐文件的质量。
