Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes

Abstract

Background The aim was to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity. Methods This was a systematic review and aggregate data meta‐analysis of RCTs and cohort studies. PubMed, MEDLINE, Embase and CINAHL Plus databases were searched from inception to February 2018. Eligibility criteria were: studies assessing the effect of weight loss interventions (low‐energy diets with or without an exercise component) on clinical outcomes in patients undergoing any surgical procedure. Data on 30‐day or all‐cause in‐hospital mortality were extracted and synthesized in meta‐analyses. Postoperative thromboembolic complications, duration of surgery, infection and duration of hospital stay were also assessed. Results A total of 6060 patients in four RCTs and 12 cohort studies, all from European and North American centres, were identified. Most were in the field of bariatric surgery and all had some methodological limitations. The pooled effect estimate suggested that preoperative weight loss programmes were effective, leading to significant weight reduction compared with controls: mean difference –7·42 (95 per cent c.i. –10·09 to –4·74) kg (P < 0·001). Preoperative weight loss interventions were not associated with a reduction in perioperative mortality (odds ratio 1·41, 95 per cent c.i. 0·24 to 8·40; I2 = 0 per cent, P = 0·66) but the event rate was low. The weight loss groups had shorter hospital stay (by 27 per cent). No differences were found for morbidity. Conclusion This limited preoperative weight loss has advantages but may not alter the postoperative morbidity or mortality risk.

Recomendaciones de actividad física y ejercicio en el paciente adulto sometido a cirugía bariátrica. Documento de Consenso

“…En la búsqueda bibliográfica no se encontraron intervenciones pre-quirúrgicas que cumplieran con las condiciones mencionadas, sin embargo, esta fase tiene muchas semejanzas con el tratamiento conservador del paciente con obesidad, buscando disminuir el peso del paciente a través de modificaciones en su alimentación 32 . Bajo este contexto el ejercicio de fuerza ha evidenciado un rol fundamental en la mantención de la masa magra 33 .…”

Role of Health Indicators in Making Choices for Health Tourism

“…-2-7 More specifically, both service and clinical quality indicators such as hospital infection rate, post-operative complications, 28 days readmission/mortality are considered as key factors for those who seek healthcare in United States. [2][3][4][5][6][7] Along these lines, for example , Roman et. al., (2018) aimed to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity.…”

Preoperative weight loss in women with obesity in gynaecologic oncology: A retrospective study

“…In this context, preoperative weight loss has been shown to decreases liver size, surgical time, blood loss, surgical difficulty and hospital stay. [12][13][14] However, the impact on perioperative complications has not been consistently demonstrated, and it has not translated into improved weight loss at 1 year after surgery. 15 In those with obesity and gastric cancer, a 20-day very low-calorie diet was seen to decrease total body fat and visceral fat mass.…”