These Guidelines are endorsed by the European Association for the Study of Obesity (EASO), International Association for the Study of Obesity (IASO), International Society for the Perioperative Care of the Obese Patient (ISPCOP), Society American Gastrointestinal Endoscopic Surgeons (SAGES), American College of Surgery (ACS), and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).
Article first published online: 26 MAR 2013
Copyright © 2013 The Obesity Society
Volume 21, Issue S1, pages S1–S27, March 2013
How to Cite
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., Dixon, J. B. and Brethauer, S. (2013), Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*. Obesity, 21: S1–S27. doi: 10.1002/oby.20461
By mutual agreement among the authors and editors of their respective journals, this work is being published jointly in Surgery for Obesity and Related Diseases 2013; doi: 10.1016/j.soard.2012.12.010, Obesity 2013; doi: 10.1002/oby.20461 and Endocrine Practice 2013; doi:10.4158/EP12437.GL.
Abbreviations: AACE, American Association of Clinical Endocrinologists; ACS, American College of Surgery; ASMBS, American Association of Metabolic and Bariatric Surgery; BAC, blood alcohol content; BED, binge eating disorder; BEL, best evidence level; BMI, body mass index; BPD-DS, biliopancreatic diversion with duodenal switch; CCS, clinical case series; CK, creatine kinase; CPAP, continuous positive airway pressure; CPG, clinical practice guidelines; CSS, cross-sectional study; CT, computerized tomography; CVD, cardiovascular disease; DCCP, diabetes comprehensive care plan; DVT, deep venous thrombosis; DXA, dual-energy x-ray absorptiometry; EL, evidence level; EN, enteral nutrition; FDA, U.S. Food and Drug Administration; GERD, gastrointestinal reflux disease; HDL, high-density lipoprotein; ICU, intensive care unit; LABS, longitudinal assessment of bariatric surgery; LAGB, laparoscopic adjustable gastric band; LDL, low-density lipoprotein; LSG, laparoscopic sleeve gastrectomy; MI, myocardial infarction; MNRCT, meta-analysis of nonrandomized controlled trials; MRCT, meta-analysis of randomized controlled trials; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NE, no evidence; NIH, National Institutes of Health; OHS, obesity hypoventilation syndrome; OSA, obstructive sleep apnea; OS-MRS, obesity surgery mortality risk score; PTH, parathyroid hormone; PCOS, polycystic ovary syndrome; PCS, prospective cohort study; PE, pulmonary embolism; PN, parenteral nutrition; PPI, proton pump inhibitor; RCT, randomized controlled trial; RML, rhabdomyolysis; RYGB, Roux-en-Y gastric bypass; SCR, single case report; SG, sleeve gastrectomy; SOS, Swedish Obesity Subjects; SS, surveillance survey; T2D, type 2 diabetes mellitus; TOS, The Obesity Society; TSH, thyroid-stimulating hormone; UGI, upper gastrointestinal; VTE, venous thromboembolism.
- Issue published online: 26 MAR 2013
- Article first published online: 26 MAR 2013
- Manuscript Accepted: 27 DEC 2012
- Manuscript Received: 23 DEC 2012
- Bariatric surgery;
- Metabolic surgery;
- Diabetes surgery;
- Metabolic syndrome;
- Clinical practice guidelines;
- Best practice guidelines;
- Weight loss surgery
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.