Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
Royal Brisbane & Women's Hospital, Queensland Health, Brisbane, QLD, Australia.
Int J Obes (Lond). 2024 Dec;48(12):1748-1757. doi: 10.1038/s41366-024-01615-2. Epub 2024 Aug 22.
This study reports the development and pilot application of the Bariatric Surgery Assessment and Prioritisation Tool (BAPT) for use in a public health system. The BAPT was designed as a patient prioritisation instrument to assess patients with excessive weight and type 2 diabetes suitable for bariatric surgery. We assessed whether the instrument successfully identified those who gained the greatest benefits including weight loss, diabetes remission, reduction in comorbidities, and health-related quality of life (HR-QoL).
The BAPT instrument was applied to score 292 patients referred for bariatric surgery in Queensland between 2017 and 2020 based on their, body mass index, diabetes status, surgical risk (e.g. pulmonary embolism) and comorbidities (e.g. non-alcoholic steatohepatitis). These data were collected at referral and at 12-months post-surgery for 130 patients and stratified by BAPT scores. Outcomes included clinical and HR-QoL.
Patients' BAPT scores ranged from 12 to 78 (possible range 2-98). Those with higher scores tended to be younger (p < 0.001), have higher BMI (p < 0.001) or require insulin to manage diabetes (p < 0.01). All patients lost similar percentages of body weight (20-25%, p = 0.73) but higher-scoring patients were more likely to discontinue oral diabetes medications (p < 0.001) and the improvement in glycated haemoglobin was four times greater in patients scoring 70-79 points compared to those scoring 20-29 (p < 0.05). Those who scored ≥ 50 on the BAPT were substantially more likely to obtain diabetes remission (57% vs 31%). BAPT scores of 40 and above tended to have greater improvement in HR-QoL.
The BAPT prioritised younger patients with higher BMIs who realised greater improvements in their diabetes after bariatric surgery. Higher-scoring BAPT patients should be prioritised for bariatric surgery as they have a greater likelihood of attaining diabetes remission.
本研究报告了用于公共卫生系统的减重手术评估和优先排序工具（BAPT）的开发和初步应用。BAPT 被设计为一种患者优先排序工具，用于评估适合减重手术的超重和 2 型糖尿病患者。我们评估了该工具是否成功地确定了那些获益最大的患者，包括体重减轻、糖尿病缓解、减少合并症和健康相关生活质量（HR-QoL）。
2017 年至 2020 年间，根据患者的体重指数、糖尿病状况、手术风险（如肺栓塞）和合并症（如非酒精性脂肪性肝炎），对昆士兰州 292 名接受减重手术的患者应用 BAPT 工具进行评分。这些数据是在转诊时和 130 名患者手术后 12 个月收集的，并根据 BAPT 评分进行分层。结果包括临床和 HR-QoL。
患者的 BAPT 评分范围为 12 至 78（可能范围为 2-98）。得分较高的患者往往更年轻（p<0.001）、体重指数更高（p<0.001）或需要胰岛素来控制糖尿病（p<0.01）。所有患者的体重减轻百分比相似（20-25%，p=0.73），但得分较高的患者更有可能停止口服糖尿病药物（p<0.001），得分在 70-79 分的患者糖化血红蛋白改善幅度是得分在 20-29 分的患者的四倍（p<0.05）。BAPT 得分≥50 的患者获得糖尿病缓解的可能性要大得多（57%比 31%）。BAPT 得分在 40 分及以上的患者 HR-QoL 改善趋势更大。
BAPT 优先考虑年轻、BMI 较高的患者，他们在减重手术后糖尿病改善程度更大。得分较高的 BAPT 患者应优先考虑进行减重手术，因为他们更有可能实现糖尿病缓解。
