The Hospital for Sick Children, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Pediatr Obes. 2024 Nov;19(11):e13119. doi: 10.1111/ijpo.13119. Epub 2024 Oct 3.
To summarize the literature on bariatric surgery for managing pediatric obesity, including intervention effects to improve patient-reported outcome measures (PROMs), cardiometabolic risk factors, anthropometry, and assess adverse events (AEs).
Eligible studies were published between January 2012 and January 2022 and included randomized controlled trials (RCTs) and observational (controlled and uncontrolled) studies before and after surgery with a mean age <18 years old. Outcomes and subgroups were selected a priori by stakeholders; estimates of effect for outcomes were presented relative to minimal important differences (MIDs) and GRADE certainty of evidence. We examined data on PROMs, cardiometabolic risk factors, anthropometry, and AEs. Subgroup analyses examined outcomes by follow-up duration and surgical technique, when possible.
Overall, 63 publications (43 original studies) met our inclusion criteria (n = 6128 participants; 66% female). Studies reported six different surgical techniques that were evaluated using uncontrolled single arm observational (n = 49), controlled observational (n = 13), and RCT (n = 1) designs. Most studies included short-term follow-up (<18 months) only. PROMs were measured in 12 (28%) studies. Surgery led to large improvements in health-related quality of life compared to baseline and control groups, and moderate to very large improvements in cardiometabolic risk factors compared to baseline. Large to very large improvements in BMIz were noted compared to baseline across all follow-up periods. There was limited evidence of AEs with most reporting mild or non-specific AEs; serious AEs were uncommon.
Bariatric surgery demonstrated primarily moderate to very large improvements across diverse outcomes with limited evidence of AEs, albeit with low to moderate certainty of evidence.
总结关于肥胖儿童管理的减重手术文献，包括改善患者报告结局指标（PROMs）、心血管代谢风险因素、人体测量学和评估不良事件（AEs）的干预效果。
合格的研究于 2012 年 1 月至 2022 年 1 月期间发表，包括手术前后的随机对照试验（RCT）和观察性（对照和非对照）研究，平均年龄<18 岁。利益相关者事先选择了结果和亚组；结果的效应估计相对于最小重要差异（MIDs）和 GRADE 证据确定性呈现。我们检查了 PROMs、心血管代谢风险因素、人体测量学和 AEs 的数据。在可能的情况下，亚组分析按随访时间和手术技术检查了结果。
总体而言，有 63 篇出版物（43 项原始研究）符合我们的纳入标准（n=6128 名参与者；66%为女性）。研究报告了六种不同的手术技术，这些技术分别使用非对照单臂观察性研究（n=49）、对照观察性研究（n=13）和 RCT（n=1）设计进行了评估。大多数研究仅包括短期随访（<18 个月）。12 项（28%）研究测量了 PROMs。与基线和对照组相比，手术导致健康相关生活质量有较大改善，与基线相比，心血管代谢风险因素有中度至非常大的改善。在所有随访期间，BMIz 都有较大至非常大的改善。大多数报告轻度或非特异性 AEs，只有有限的 AEs 证据；严重 AEs 并不常见。
减重手术在不同结局方面表现出主要为中度至非常大的改善，伴有有限的 AEs 证据，尽管证据确定性为低至中度。
