Alexandra Gower, Nicholas Evennett, Grant Beban, Elaine Yi, Elizabeth Chen
{"title":"通过取消强制性体重减轻目标,改善公费减肥手术项目的公平性。","authors":"Alexandra Gower, Nicholas Evennett, Grant Beban, Elaine Yi, Elizabeth Chen","doi":"10.1007/s11695-024-07427-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study will review postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme.</p><p><strong>Methods: </strong>A retrospective analysis of 231 patients who underwent bariatric surgery at Auckland City Hospital from 2018 to 2021 was performed. Nineteen patients were lost to follow up and 12 were excluded (revision surgery or pregnancy). The comparison group of 100 consecutive patients, retrospective from 2017, had been required to lose 10% of excess body weight preoperatively to qualify for surgery. Outcomes assessed were weight loss and diabetes resolution at 12 months, and postoperative complications within 90 days.</p><p><strong>Results: </strong>Elimination of preoperative weight loss targets was associated with greater numbers of Māori and Pacific patients undergoing bariatric surgery. There was no significant difference in weight loss outcomes or postoperative complications.</p><p><strong>Conclusion: </strong>Elimination of preoperative weight loss targets improves access to bariatric surgery for Māori and Pacific patients, inequitably affected by obesity. Removal of preoperative weight loss targets does not adversely affect weight loss outcomes, or postoperative complications, thus supporting their elimination.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving Equity of Access to a Publicly Funded Bariatric Surgery Programme by Removal of Mandatory Weight Loss Targets.\",\"authors\":\"Alexandra Gower, Nicholas Evennett, Grant Beban, Elaine Yi, Elizabeth Chen\",\"doi\":\"10.1007/s11695-024-07427-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study will review postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme.</p><p><strong>Methods: </strong>A retrospective analysis of 231 patients who underwent bariatric surgery at Auckland City Hospital from 2018 to 2021 was performed. Nineteen patients were lost to follow up and 12 were excluded (revision surgery or pregnancy). The comparison group of 100 consecutive patients, retrospective from 2017, had been required to lose 10% of excess body weight preoperatively to qualify for surgery. Outcomes assessed were weight loss and diabetes resolution at 12 months, and postoperative complications within 90 days.</p><p><strong>Results: </strong>Elimination of preoperative weight loss targets was associated with greater numbers of Māori and Pacific patients undergoing bariatric surgery. There was no significant difference in weight loss outcomes or postoperative complications.</p><p><strong>Conclusion: </strong>Elimination of preoperative weight loss targets improves access to bariatric surgery for Māori and Pacific patients, inequitably affected by obesity. Removal of preoperative weight loss targets does not adversely affect weight loss outcomes, or postoperative complications, thus supporting their elimination.</p>\",\"PeriodicalId\":19460,\"journal\":{\"name\":\"Obesity Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Obesity Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11695-024-07427-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obesity Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11695-024-07427-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/10 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Improving Equity of Access to a Publicly Funded Bariatric Surgery Programme by Removal of Mandatory Weight Loss Targets.
Introduction: Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study will review postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme.
Methods: A retrospective analysis of 231 patients who underwent bariatric surgery at Auckland City Hospital from 2018 to 2021 was performed. Nineteen patients were lost to follow up and 12 were excluded (revision surgery or pregnancy). The comparison group of 100 consecutive patients, retrospective from 2017, had been required to lose 10% of excess body weight preoperatively to qualify for surgery. Outcomes assessed were weight loss and diabetes resolution at 12 months, and postoperative complications within 90 days.
Results: Elimination of preoperative weight loss targets was associated with greater numbers of Māori and Pacific patients undergoing bariatric surgery. There was no significant difference in weight loss outcomes or postoperative complications.
Conclusion: Elimination of preoperative weight loss targets improves access to bariatric surgery for Māori and Pacific patients, inequitably affected by obesity. Removal of preoperative weight loss targets does not adversely affect weight loss outcomes, or postoperative complications, thus supporting their elimination.
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.