Oria H E, Moorehead M K
Department of Surgery, Spring Branch Medical Center, Houston, Texas, USA.
Obes Surg. 1998 Oct;8(5):487-99. doi: 10.1381/096089298765554043.
The lack of standards for comparison of results was identified by the NIH Consensus Conference panelists as one of the key problems in evaluating reports in the surgical treatment of severe obesity. The analysis of outcomes after bariatric surgery should include weight loss, improvement in comorbidities related to obesity, and quality-of-life (QOL) assessment. Definitions of success and failure should be established and the presentation of results standardized.
A survey among experienced bariatric surgeons was conducted to study the reporting of results. The concept of evaluating outcomes by using a scoring system was introduced in 1997 and has now been refined further. Psychologists with expertise in bariatrics were asked to recommend a disease-specific instrument to analyze QOL after surgery.
The system defines five outcome groups (failure, fair, good, very good, and excellent), based on a scoring table that adds or subtracts points while evaluating three main areas: percentage of excess weight loss, changes in medical conditions, and QOL. To assess changes in QOL after treatment, this method incorporates a specifically designed patient questionnaire that addresses self-esteem and four daily activities. Complications and reoperative surgery deduct points, thus avoiding the controversy of considering reoperations as failures.
The Bariatric Analysis and Reporting Outcome System (BAROS) analyzes outcomes in a simple, objective, unbiased, and evidence-based fashion. It can be adapted to evaluate other forms of medical intervention for the control of obesity. This method should be considered by international organizations for the adoption of standards for the outcome assessment of bariatric treatments, and for the comparison of results among surgical series. These standards could also be used to compare the long-term effects of surgery with nonoperative weight loss methods.
美国国立卫生研究院共识会议的专家小组成员认为，缺乏结果比较标准是评估重度肥胖手术治疗报告时的关键问题之一。减肥手术结果分析应包括体重减轻情况、与肥胖相关的合并症改善情况以及生活质量（QOL）评估。应明确成功与失败的定义，并使结果呈现标准化。
对经验丰富的减肥外科医生进行了一项调查，以研究结果报告情况。1997年引入了使用评分系统评估结果的概念，目前该概念已进一步完善。邀请了在减肥领域具有专业知识的心理学家推荐一种针对特定疾病的工具，以分析术后的生活质量。
该系统基于一个评分表定义了五个结果组（失败、一般、良好、非常好和优秀），在评估三个主要领域时进行加分或减分：超重减轻百分比、医疗状况变化和生活质量。为评估治疗后生活质量的变化，该方法纳入了一份专门设计的患者问卷，涉及自尊和四项日常活动。并发症和再次手术会扣分，从而避免了将再次手术视为失败的争议。
减肥分析与报告结果系统（BAROS）以简单、客观、无偏见且基于证据的方式分析结果。它可适用于评估控制肥胖的其他形式的医学干预。国际组织在采用减肥治疗结果评估标准以及比较不同手术系列的结果时，应考虑这种方法。这些标准还可用于比较手术与非手术减肥方法的长期效果。
