Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence
| Autor: | Braden J. Manns, Shahzeer Karmali, Daniel W. Birch, Marcello Tonelli, Natasha Wiebe, Raj Padwal, Scott Klarenbach, Maureen Hazel, Arya M. Sharma |
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| Rok vydání: | 2011 |
| Předmět: |
Sleeve gastrectomy
medicine.medical_specialty Cost-Benefit Analysis medicine.medical_treatment Bariatric Surgery Reviews law.invention Randomized controlled trial Quality of life law Weight loss Weight Loss Internal Medicine medicine Animals Humans Obesity Randomized Controlled Trials as Topic Evidence-Based Medicine business.industry medicine.disease Comorbidity Obesity Morbid Surgery Treatment Outcome Observational study medicine.symptom Complication business |
| Zdroj: | Journal of General Internal Medicine. 26:1183-1194 |
| ISSN: | 1525-1497 0884-8734 |
| DOI: | 10.1007/s11606-011-1721-x |
| Popis: | Use of bariatric surgery for severe obesity has increased dramatically. To systematically review 1. the clinical efficacy and safety, 2. cost-effectiveness of bariatric surgery, and 3. the association between number of surgeries performed (surgical volume) and outcomes. MEDLINE (from 1950), EMBASE (from 1980), CENTRAL, EconLit, EURON EED, Harvard Center for Risk Analysis, trial registries and HTA websites were searched to January 2011. 1. Randomized controlled trials (RCTs) and 2. cost-utility and cost-minimisation studies comparing a contemporary bariatric surgery (i.e., adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) to another contemporary surgical comparator or a non-surgical treatment or 3. Any study reporting the association between surgical volume and outcome. Outcomes included changes in weight and obesity-related comorbidity, quality of life and mortality, surgical complications, resource utilization, and incremental cost-utility. RCT data evaluating mortality and obesity-related comorbidity endpoints were lacking. A small RCT of 16 patients reported that adjustable gastric banding reduced weight by 27% (p < 0.01) compared to diet-treated controls over 40 weeks. Six small RCTs reported comparisons of commonly used, contemporary procedures. Gastric banding reduced weight to a lower extent than gastric bypass and sleeve gastrectomy and resulted in shorter operating times, fewer serious complications, lower weight loss efficacy, and more frequent reoperations compared to gastric bypass. Sleeve gastrectomy and gastric bypass reduced weight to a similar extent. A 2-year RCT in 50 adolescents reported that gastric banding substantially reduced weight compared to lifestyle modification (35 kg vs. 3 kg; p |
| Databáze: | OpenAIRE |
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