Hackensack University Medical Center, Hackensack, NJ, USA.
Obes Surg. 2020 Sep;30(9):3333-3340. doi: 10.1007/s11695-020-04692-0.
BACKGROUND/INTRODUCTION: Qualification for bariatric surgery is based upon strict medical guidelines, but individual insurance companies may introduce additional requirements for approval and coverage as they deem necessary. A mandatory preoperative medical weight loss management (MWM) program is commonly such a requirement.
The primary objective of this study is to assess the effect of MWM programs on weight loss outcomes.
A retrospective review of all sleeve gastrectomies performed between 2012 and 2016 at our institution was conducted. Patients were divided into two groups: those who required a preoperative MWM program, and those who did not. A 1:1 greedy nearest-neighbor method matching algorithm was used to match patients based on age, BMI, smoking, gender, race, sleep apnea, and diabetes. Total weight loss and percent excess weight loss at 1 year for each group were compared.
A total of 3059 sleeve gastrectomy patients were reviewed. Of these, 941 patients had adequate data points to be evaluated. The matching algorithm resulted in 530 patients for the final analysis, 265 patients in each group. There were no significant differences between the groups in terms of age, BMI, smoking, gender, race, sleep apnea, or diabetes. A paired t test found no significant differences between the MWM group and the control group at 1 year in both total weight loss (36.7 kg vs 36.2 kg) and in percent excess weight loss (56.5% vs 55.8%, p = 0.24).
There was no significant difference in weight loss outcomes after 1 year in patients required by insurance to participate in MWM programs compared to those who were not. The necessity of these programs should be questioned.
背景/引言：减重手术的资格基于严格的医学指南，但个别保险公司可能会根据需要引入额外的批准和覆盖要求。强制性术前医学减重管理（MWM）计划通常就是这样的要求。
本研究的主要目的是评估 MWM 计划对减重效果的影响。
对我院 2012 年至 2016 年间进行的所有袖状胃切除术进行回顾性研究。患者分为两组：需要术前 MWM 计划的患者和不需要的患者。使用 1:1 贪婪最近邻匹配算法根据年龄、BMI、吸烟、性别、种族、睡眠呼吸暂停和糖尿病对患者进行匹配。比较每组患者术后 1 年的总减重和超体重百分比。
共回顾了 3059 例袖状胃切除术患者。其中，941 例患者有足够的数据点进行评估。匹配算法最终得出 530 例患者用于最终分析，每组 265 例。两组患者在年龄、BMI、吸烟、性别、种族、睡眠呼吸暂停或糖尿病方面无显著差异。配对 t 检验发现，MWM 组和对照组在术后 1 年的总减重（36.7kg 与 36.2kg）和超体重百分比（56.5%与 55.8%）方面无显著差异（p=0.24）。
与未参加 MWM 计划的患者相比，参加保险要求参加 MWM 计划的患者术后 1 年的减重效果无显著差异。这些计划的必要性值得质疑。
