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.
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.