Revisión de conjuntoCriterios de calidad en cirugía bariátrica: revisión de conjunto y recomendaciones de la Asociación Española de Cirujanos y de la Sociedad Española de Cirugía de la ObesidadQuality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery
Section snippets
Introducción
La cirugía bariátrica ha demostrado su eficacia para el control de la obesidad mórbida y del síndrome metabólico, con una superioridad clara respecto a los tratamientos médicos1, 2. Es imprescindible establecer cuáles son los criterios de calidad que definen la «buena práctica» en cirugía bariátrica para poder contrastar los resultados y saber si estamos ofreciendo un tratamiento quirúrgico eficaz. Teniendo en cuenta que la pérdida del seguimiento de los pacientes es el principal factor
Búsqueda
Se realizó una búsqueda bibliográfica en grupos de 2 miembros de la Sección de Obesidad Mórbida de la AEC y en 3 bases de datos bibliográficas (Pubmed, Scopus y Web of Science) con los términos «bariatric surgery and weight loss results/excess weight loss», «bariatric surgery and comorbidities/diabetes mellitus/ cholesterol/ dyslipidaemia/ obstructive apnea/hypertension», «bariatric surgery and morbidity/complications», «bariatric surgery and mortality», «bariatric surgery and revisional
Resultados
En la tabla 1 se resumen los principales indicadores de calidad, objetivos y su grado de recomendación. En el caso de las comorbilidades, los indicadores son sustituidos por los criterios de remisión. La tabla 2 recoge el resumen de las recomendaciones.
Estándares de calidad de la pérdida de peso: la pérdida de peso debe medirse a través de las nuevas herramientas existentes, que minimizan el sesgo que supone emplear el índice de masa corporal inicial
La completa normalización del peso no es una condición indispensable para obtener una mejora significativa de la salud5. Algunos autores defienden que es más importante la mejora de las comorbilidades y la repercusión social, que la cuantificación del peso perdido6. Desde 1981 se propuso utilizar el porcentaje de sobrepeso perdido (%PSP) para cuantificar el resultado de la cirugía bariátrica, poniendo el límite del éxito en el 50% del PSP7, 8. En 1997, Baltasar et al.9 propusieron considerar
Limitaciones
Este trabajo es fruto de la colaboración conjunta entre diferentes miembros de las sociedades científicas representadas. El principal objetivo ha sido identificar cuáles son los indicadores objetivos y los criterios mínimos de calidad en el contexto global de la cirugía bariátrica. Nuestro propósito no ha sido realizar una comparación sistemática entre las diferentes técnicas quirúrgicas, por lo que no se pueden extrapolar con el suficiente análisis y rigor científico unas recomendaciones
Conclusiones
Los avances tecnológicos, la mejor formación de los equipos multidisciplinares y la simplificación de las técnicas quirúrgicas laparoscópicas han convertido a la cirugía bariátrica en una de las más seguras y eficaces; pero esta eficacia y seguridad debe estar contrastada a partir de unos requerimientos mínimos en los resultados. Las guías de práctica clínica existentes no siempre incluyen criterios estrictos, de ahí que el establecimiento de unos estándares de calidad y unas recomendaciones
Autoría/colaboraciones
Diseño, recogida de datos y redacción: Fátima Sabench Pereferrer, Eduardo Domínguez-Adame Lanuza, Ainitze Ibarzabal Olano, María Socas Macias y Víctor Valentí Azcárate.
Revisión de resultados: Amador García Ruiz de Gordejuela y Francisca García-Moreno Nisa, Jesús González, Fernández, Ramón Vilallonga Puy y Nuria Vilarrasa García.
Revisión crítica del manuscrito: Raquel Sánchez Santos y Fátima Sabench Pereferrer
Soporte institucional y revisión de resultados: Asociación Española de Cirujanos y
Conflicto de intereses
Los autores declaran no tener ningún conflicto de intereses.
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Cited by (39)
Recommendations on the management of severe obesity in patients with inflammatory bowel disease of the Spanish Group on Crohn's Disease and Ulcerative Colitis (GETECCU), Spanish Society of Obesity (SEEDO), Spanish Association of Surgery (AEC) and Spanish Society of Digestive Endoscopy (SEED)
2024, Gastroenterologia y HepatologiaBariatric surgery and inflammatory bowel disease: An increasingly frequent reality
2023, Cirugia EspanolaLearning from error in bariatric surgery: analysis of malpractice closed claims in Spain
2023, Surgery for Obesity and Related DiseasesEnablers and barriers to prevent weight-regain post bariatric surgery – A qualitative enquiry
2022, Eating BehaviorsCitation Excerpt :Excess body fat is associated with adverse health outcomes, including type two diabetes mellitus (T2DM), cardiovascular disease, stroke, sleep apnoea, reproductive abnormalities, osteoarthritis, and several cancers, impacting both the individual and society (Morar et al., 2021). Bariatric surgery is an increasingly common treatment for severe obesity (Cummings, Overduin, & Foster-Schubert, 2004), using malabsorption and/or restrictive physiological changes (Sabench Pereferrer et al., 2017). It poses many potential health benefits, including weight loss, reduced obesity-associated co-morbidities (e.g., diabetes, hypertension, etc.) and in some, complete resolution, reduced mortality, improved functional ability, and health-related quality of life (QOL) (Buchwald et al., 2004; Sabench Pereferrer et al., 2017; Welbourn et al., 2018).
Methodological appraisal of the evidence about efficacy of metabolic surgery in adults with non-morbid obesity and hypertension: An overview of systematic reviews
2022, International Journal of SurgeryCitation Excerpt :However, in this review, there was evidence of a greater loss with Roux-en-Y bypass, suggesting that this result could be due to its high malabsorptive component [48]. On the other hand, success in weight loss depends not only on the technique but also on the multidisciplinary team as well as good patient selection and follow-up [49]. These conditions, however, were not evaluated.