Disease-Based Criteria vs BMI Level for Prioritization of Metabolic Surgery.

IF 2.9 3区 医学 Q1 SURGERY
Obesity Surgery Pub Date : 2025-06-01 Epub Date: 2025-05-17 DOI:10.1007/s11695-025-07896-4
Pia Roser, Robert D McIntyre, Simone Cremona, Adel Assiri, Lyz Bezerra Silva, Ghassan Chamseddine, Francesco Rubino
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引用次数: 0

Abstract

Background: BMI is widely used as a primary criterion for prioritizing candidates for metabolic surgery. However, it may not fully capture disease severity or mortality risks associated with comorbidities such as type 2 diabetes (T2D) and cardiovascular disease (CVD). This study aimed to assess whether BMI accurately reflects disease burden and risk in patients undergoing metabolic surgery.

Methods: A retrospective audit included 723 adult candidates for primary metabolic surgery at a tertiary care center between January 2014 and December 2022. Patients undergoing revisional surgeries were excluded. Clinical data, including demographics, comorbidities, and disease severity indicators (e.g., ASA score, Charlson Comorbidity Index [CCI], medication usage, and estimated 10-year survival), were analyzed. Patients were grouped by BMI (< or ≥ 50 kg/m2), T2D, and CVD status for comparison.

Results: Prevalence rates for T2D, BMI ≥ 50 kg/m2, and CVD were 41.6%, 37.3%, and 16.2%, respectively. Patients with BMI ≥ 50 kg/m2 were generally younger, had fewer comorbidities, lower CVD prevalence, and better estimated 10-year survival than those with BMI < 50 kg/m2. In contrast, patients with T2D and CVD had significantly higher ASA and CCI scores, greater medication usage, and reduced 10-year survival (p < 0.001 for T2D; p < 0.01 for CVD).

Conclusion: Higher BMI levels do not reflect greater disease burden and mortality risk among candidates for bariatric/metabolic surgery. These findings do not support the use of high BMI-based thresholds (e.g., ≥ 50 kg/m2) as criteria for expedited access. Clinically relevant measures of baseline disease burden should be used to determine the urgency of access to surgical treatment of obesity and T2D.

基于疾病的标准与BMI水平对代谢手术优先级的影响。
背景:BMI被广泛用作优先选择代谢手术候选人的主要标准。然而,它可能无法完全捕获与2型糖尿病(T2D)和心血管疾病(CVD)等合并症相关的疾病严重程度或死亡风险。本研究旨在评估BMI是否能准确反映代谢手术患者的疾病负担和风险。方法:回顾性审计包括2014年1月至2022年12月在三级保健中心接受初级代谢手术的723名成人候选人。接受翻修手术的患者排除在外。分析临床数据,包括人口统计学、合并症和疾病严重程度指标(如ASA评分、Charlson合并症指数[CCI]、药物使用情况和估计的10年生存率)。患者按BMI(2)、T2D和CVD状态分组进行比较。结果:T2D患病率为41.6%,BMI≥50 kg/m2患病率为37.3%,CVD患病率为16.2%。BMI≥50 kg/m2的患者通常更年轻,合并症更少,心血管疾病患病率更低,与BMI为2的患者相比,估计10年生存率更高。相比之下,T2D和CVD患者的ASA和CCI评分明显较高,用药较多,10年生存率降低(p)。结论:BMI水平较高并不反映减肥/代谢手术候选人的疾病负担和死亡风险较高。这些发现不支持使用基于bmi的高阈值(例如≥50 kg/m2)作为加速准入的标准。应使用基线疾病负担的临床相关测量来确定获得肥胖和T2D手术治疗的紧迫性。
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
Obesity Surgery
Obesity Surgery 医学-外科
CiteScore
5.80
自引率
24.10%
发文量
567
审稿时长
3-6 weeks
期刊介绍: Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.
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