肥胖与代谢外科围手术期营养、代谢及非手术支持临床实践指南 2019 年更新版：美国临床内分泌医师协会/美国内分泌学会、美国肥胖学会、美国代谢与减肥外科学会、肥胖医学协会及美国麻醉医师学会共同赞助

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.

机构信息

Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE.

Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.

出版信息

Obesity (Silver Spring). 2020 Apr;28(4):O1-O58. doi: 10.1002/oby.22719.

DOI:10.1002/oby.22719

PMID:32202076

Abstract

OBJECTIVE

The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.

METHODS

Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.

RESULTS

New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).

CONCLUSIONS

Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

摘要

目的

这些更新的临床实践指南（CPG）是由美国临床内分泌医师协会（AACE）、肥胖学会（TOS）、美国代谢与减肥外科学会（ASMBS）、肥胖医学协会（OMA）和美国麻醉师协会（ASA）董事会委托制定的，遵循 AACE 2017 年关于 CPG、算法和检查表标准化制作的协议。

方法

根据 2013 年至今的新证据和专家提供的主观因素，对每个建议进行评估和更新。

结果

本 CPG 的新或更新主题包括：基于肥胖的慢性疾病并发症为中心的模型中的语境化、基于细微差别和算法/检查表辅助的程序选择临床决策、新型减肥手术、减肥手术后恢复协议的增强，以及当前医疗保健领域的后勤问题（包括成本因素）。共有 85 项编号建议更新了支持证据，其中 61 项被修订，12 项为新增建议。需要注意的是，在单个编号建议中可能有多个建议陈述，其中 31 项（13%）为 A 级、42 项（17%）为 B 级、72 项（29%）为 C 级和 101 项（41%）为 D 级建议。共有 858 个引文，其中 81 个（9.4%）为证据水平（EL）1（最高）、562 个（65.5%）为 EL 2、72 个（8.4%）为 EL 3、143 个（16.7%）为 EL 4（最低）。