Jackson Theresa N, Cox Bradley P, Grinberg Gary G, Yenumula Panduranga R, Lim Robert B, Chow Geoffrey S, Khorgami Zhamak
Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California.
Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma.
Surg Obes Relat Dis. 2023 Nov;19(11):1255-1262. doi: 10.1016/j.soard.2023.05.014. Epub 2023 May 22.
National and international consensus statements, as well as the National Institutes of Health (NIH), support the use of bariatric surgery for the treatment of class I obesity. Despite this, most payors within the United States limit reimbursement to the outdated 1991 NIH guidelines or a similar adaptation.
This study aimed to determine the safety of bariatric surgery in patients with lower BMI compared with standard patients, as well as determine U.S. utilization of bariatric surgery in class I obesity in 2015-2019.
A retrospective analysis was performed of the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass patients were divided into body mass index cohorts: class I obesity (<35 kg/m) and severe obesity (≥35 kg/m). Differences in preoperative patient selection and postoperative outcomes were established, and frequency trends were delineated.
Analysis included 760,192 surgeries with 8129 (1%) for patients with class I obesity. The patients with class I obesity were older, more commonly female, and with lower American Society of Anesthesiologists (ASA) class, but with higher rates of type 2 diabetes, hyperlipidemia, and gastroesophageal reflux disease (P < .05). Variation was found for operative time, length of stay, 30-day readmission, and composite morbidity. Minimal annual variation was found for bariatric surgeries performed for patients with class I obesity.
The short-term safety of bariatric surgery in patients with class I obesity was corroborated by this study. Despite consensus statements and robust support, rates of bariatric surgery in patients with class I obesity have failed to increase and remain limited to 1%. This demonstrates the impact of the outdated 1991 NIH guidelines regarding access to care for these potentially life-saving surgeries.
国内和国际共识声明以及美国国立卫生研究院（NIH）均支持采用减肥手术治疗I类肥胖症。尽管如此，美国大多数医保支付方仍将报销限制在过时的1991年NIH指南或类似的调整标准内。
本研究旨在确定与标准患者相比，体重指数较低的患者接受减肥手术的安全性，并确定2015 - 2019年美国I类肥胖症患者减肥手术的使用情况。
对2015 - 2019年代谢与减肥手术认证及质量改进项目（MBSAQIP）数据库进行回顾性分析。
将腹腔镜袖状胃切除术和腹腔镜Roux - en - Y胃旁路手术患者分为体重指数队列：I类肥胖（<35 kg/m²）和重度肥胖（≥35 kg/m²）。确定术前患者选择和术后结果的差异，并描绘频率趋势。
分析包括760,192例手术，其中8129例（1%）为I类肥胖患者。I类肥胖患者年龄较大，女性更为常见，美国麻醉医师协会（ASA）分级较低，但2型糖尿病、高脂血症和胃食管反流病的发生率较高（P < 0.05）。手术时间、住院时间、30天再入院率和综合发病率存在差异。I类肥胖患者接受减肥手术的年度变化极小。
本研究证实了I类肥胖患者接受减肥手术的短期安全性。尽管有共识声明和有力支持，但I类肥胖患者的减肥手术率未能增加，仍局限于1%。这表明了过时的1991年NIH指南对这些可能挽救生命的手术获得治疗机会的影响。
