Missing Something? Comparisons of Effectiveness and Outcomes of Bariatric Surgery Procedures and Their Preferred Reporti
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REVIEW
Missing Something? Comparisons of Effectiveness and Outcomes of Bariatric Surgery Procedures and Their Preferred Reporting: Refining the Evidence Base Walid El Ansari 1,2,3
&
Kareem El-Ansari 4
# The Author(s) 2020
Abstract Comparisons of effectiveness of bariatric surgery (BS) procedures encompass weight loss, metabolic/clinical outcomes, and improvements or worsening of comorbidities. Post-operative physical activity (PA) and diet influence such outcomes but are frequently not included in comparisons of effectiveness. We assessed the value and necessity of including post-operative PA/diet data when comparing effectiveness of BS. Including post-operative PA/diet data has significant benefits for BS and patients. The paper proposes an explicit preferred reporting system (Preferred REporting of post-operative PHYsical activity and Diet data in comparisons of BS effectiveness: PRE-PHYD Bariatric). Including post-operative PA/diet data could result in more accurate appraisals of effectiveness of BS procedures. This could translate into better ‘individualized’ BS by achieving a better ‘fit’ between patient and procedure. Keywords Post-operative . Bariatric surgery . Physical activity . Diet . Effectiveness . Outcomes . Preferred reporting
Introduction Comparisons of short-, medium-, or long-term effectiveness and outcomes of various bariatric surgery (BS) procedures, and comparisons of effectiveness and outcomes of BS vs no surgery usually encompass a range of variables. Important outcomes include safety (e.g., adverse events, operative mortality, perioperative complications, readmissions, long-term reoperation rates) or other relevant indicators (e.g., length of hospital stay) [1–7]. In addition to such variables, the indicators of KE-A was a volunteer at Hamad Medical Corporation at the time of preparation and writing of the manuscript. * Walid El Ansari [email protected] Kareem El-Ansari [email protected]
effectiveness employed for comparisons frequently comprise three main components. These components include various anthropometric weight loss (WL) measures [e.g., WL, BMI, %BMI change, % excess BMI loss, percent total weight loss (%TWL), percent excess weight loss (%EWL), others)], a range of biochemical/ metabolic/clinical outcomes (FBG, HA1c, lipids, others), and improvements or worsening of comorbidities (e.g., type 2 diabetes mellitus) that are frequently gauged based on the post-BS levels of biochemical/clinical parameters [4, 7, 8]. However, the extent and quality of a patient’s post-operative (post-op) physical activity (PA) and/or diet can both influence these anthropometric WL and biochemical/ clinical outcomes, directly (e.g., via WL) or indirectly (e.g., via improvements in insulin sensitivity, metabolic health). It therefore seems important to include information on post-op PA and diet in analyses of comparisons of effectiveness of various BS procedures for a more ‘realistic’ appraisal. In practice, this seems not to be always the case. These considerations inspired the current re
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