Intentional weight reduction before surgery – A systematic review

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-02-01 DOI:10.1016/j.clnu.2025.01.008

Erik Stenberg , Anna Laurenius , Anders Thorell

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引用次数: 0

Abstract

Introduction

Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200 kcal/day) or very low energy diet (VLED, ≤800 kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine.

Methods

The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses.

Results

A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95 % CI 0.14–0.59, p = 0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51–0.79, p < 0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes.

Conclusion

The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures.

Registration

The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.

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术前有意减肥-系统综述。

肥胖可能会增加手术过程的复杂性，增加围手术期并发症的风险。通过使用低能量饮食（LED，≤1200千卡/天）或极低能量饮食（VLED，≤800千卡/天）来减轻体重可以减少减肥手术后的术后并发症，但对于大多数其他类型的手术，其使用的证据仍不确定。因此，本系统综述的目的是对这一常规的科学证据进行总体评价。方法：使用Cochrane观察性研究偏倚风险评估工具和NIH随机试验对照干预研究质量评估工具，检索截至2024年11月20日的Medline、Embase、Web of Science和Cochrane数据库。以手术时间、术者感知难度、术中并发症、术后并发症及特定手术的相关疗效指标为终点。随机效应模型用于汇总主要分析的效应大小。结果：共纳入7053项研究。通过题目和摘要筛选，然后是全文筛选，剩下18项研究（9项随机对照试验和9项观察性研究）用于分析，包括854名接受干预的患者和979名对照组。术前LED/VLED可缩短手术时间（标准平均差0.36,95%CI 0.14-0.59, p = 0.002），降低减重手术、胆囊切除术、结直肠手术和疝修补术后并发症的风险（合并RR 0.63, 95%CI 0.51-0.79, p）。该结果支持LED/VLED用于计划进行减肥手术的肥胖患者以及接受胆囊切除术，结直肠手术和疝气修复的患者的短期术前体重减轻。需要进一步的研究，包括一个可比的对照组来评估其在其他外科手术中的常规应用。注册：本研究的方案在国际前瞻性系统评价注册系统（PROSPERO）进行了预注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.