AACE/TOS/ASMBS/OMA/ASA 2019 Guidelines
Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists*

https://doi.org/10.4158/GL-2019-0406Get rights and content

ABSTRACT

Objective

The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.

Methods

Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.

Results

New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).

Conclusion

Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. (Endocr Pract. 2019;25:1-75)

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*These guidelines are endorsed by the American Society for Nutrition (ASN), American Society for Parenteral and Enteral Nutrition (ASPEN), International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), International Society for the Perioperative Care of the Obese Patient (ISPCOP), and Obesity Action Coalition (OAC).

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, Obesity, and Endocrine Practice. © AACE 2019. DOI: 10.4158/GL-2019-0406

Address reprint requests to [email protected].

Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on November 4, 2019. DOI: 10.4158/GL-2019-0406.GL

American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists medical guidelines for clinical practice are systematically developed statements to assist health-care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on clinical evidence. In areas of uncertainty, or when clarification is required, expert opinion and professional judgment were applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made considering local resources and individual patient circumstances.

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