Chinese expert consensus on case management of preoperative clinical pathways of bariatric and metabolic surgery (2023 edition)

doi:10.3877/cma.j.issn.2095-9605.2023.02.001

Abstract

Abstract:

Objective

This expert consensus aims to promote the construction and development of bariatric and metabolic surgery, make preoperative case management more standardized, and provide reference for preoperative clinical nursing work.

Methods

Experts and scholars from 33 hospitals or universities, who are experienced in case management, medical and nursing treatment of bariatric and metabolic surgery, formulate the expert recommendation committee. Six experts with more than three years of related experience in case management of bariatric and metabolic surgery are interviewed, and the main writers form the first draft of expert recommendations. Then the first round of discussion is completed by the 6 interviewed experts in the form of letter review. On this basis, 40 experts in relevant fields are invited to collect modification opinions on the revised expert recommendation in the form of letter review to complete the second round of expert discussion. Finally, consultants of the expert recommendation committee are invited to complete the third round of expert discussion and form the final draft of expert recommendation via online meeting.

Results

This expert consensus includes case management content for patients before admission (pre-hospital consultation and notification content, pre-hospital health education and intervention, pre-hospital bed reservation) and after admission (data collection and admission introduction, examination and testing management, clinical care), and the preparation of a clinical pathway template document.

Conclusions

This consensus can provide reference for case management of preoperative clinical pathways of bariatric and metabolic surgery. In the future, regular updates will be made after further summarizing experience and accumulating evidence-based medical evidence to better serve the clinic.

Key words: Obesity, Case management, Clinical pathways, Bariatric surgery, Metabolic surgery, Expert consensus

Chinese Society for Metabolic and Bariatric Surgery, Chinese Obesity and Metabolic Surgery Collaborative. Chinese expert consensus on case management of preoperative clinical pathways of bariatric and metabolic surgery (2023 edition)[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(02): 73-82.

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References 39

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项目	具体内容	第1轮投票结果（分）	第2轮投票结果（分）
入院前咨询告知	1.手术适应证	5.00	4.95
	2.手术禁忌证	5.00	4.95
	3.手术方式	5.00	4.98
	4.术后并发症	5.00	4.90
	5.入院流程及住院时间	5.00	4.80
	6.手术费用	5.00	4.73
	7.预约床位	5.00	4.55
	8.住院所需物品及注意事项	5.00	4.63
	9.国家医疗保险报销政策	5.00	4.65
	10.国家医疗保险报销注意事项（异地就医备案等）	5.00	4.73

项目	具体内容	第1轮投票结果（分）	第2轮投票结果（分）
入院前咨询告知	1.手术适应证	5.00	4.95
	2.手术禁忌证	5.00	4.95
	3.手术方式	5.00	4.98
	4.术后并发症	5.00	4.90
	5.入院流程及住院时间	5.00	4.80
	6.手术费用	5.00	4.73
	7.预约床位	5.00	4.55
	8.住院所需物品及注意事项	5.00	4.63
	9.国家医疗保险报销政策	5.00	4.65
	10.国家医疗保险报销注意事项（异地就医备案等）	5.00	4.73

项目	具体内容	第1轮投票结果（分）	第2轮投票结果（分）
入院前健康宣传教育及干预	1.了解患者病史并做好登记，给予专科指导	4.60	4.98
	2.提前进行特殊药物指导：阿司匹林、硫酸氢氯吡格雷、华法林等抗凝药物，术前2~7 d停药^[24,25]；降血压药利血平术前7 d停药，可改用其他降血压药^[26]	5.00	5.00
	3.提前告知患者术前6周戒烟并限酒^[21,27]	5.00	4.88
	4.指导BMI≥50 kg/m²或合并重度睡眠呼吸暂停综合征的患者进行呼吸功能锻炼，增强患者肺活量以利于提高手术安全性、缩短住院时间^[28,29]	5.00	4.90
	5.评估患者入院前心肺功能（心悸、呼吸困难、乏力、嗜睡等）及日常生活活动范围，进行入院前指导^[30]	5.00	4.85
	6.提前做好患者入院前血糖评估，了解其空腹血糖，餐前、餐后2 h血糖及糖化血红蛋白	5.00	4.90
	7.患者空腹血糖≥16.7 mmol/L时，评估是否接受院前内分泌科治疗，控制血糖<10.0 mmol/L后再入院；建议患者术前糖化血红蛋白≤6.5%，空腹血糖≤6.1 mmol/L，餐后2 h血糖≤7.8 mmol/L；对于因糖尿病相关并发症或广泛合并症的患者，以及无法安全达到血糖较低指标的患者，建议术前糖化血红蛋白控制在7%~8%；对于术前糖化血红蛋白≥8%的患者，应结合临床实际情况谨慎选择手术^[27,31]	5.00	4.98

项目	具体内容	第1轮投票结果（分）	第2轮投票结果（分）
入院前健康宣传教育及干预	1.了解患者病史并做好登记，给予专科指导	4.60	4.98
	2.提前进行特殊药物指导：阿司匹林、硫酸氢氯吡格雷、华法林等抗凝药物，术前2~7 d停药^[24,25]；降血压药利血平术前7 d停药，可改用其他降血压药^[26]	5.00	5.00
	3.提前告知患者术前6周戒烟并限酒^[21,27]	5.00	4.88
	4.指导BMI≥50 kg/m²或合并重度睡眠呼吸暂停综合征的患者进行呼吸功能锻炼，增强患者肺活量以利于提高手术安全性、缩短住院时间^[28,29]	5.00	4.90
	5.评估患者入院前心肺功能（心悸、呼吸困难、乏力、嗜睡等）及日常生活活动范围，进行入院前指导^[30]	5.00	4.85
	6.提前做好患者入院前血糖评估，了解其空腹血糖，餐前、餐后2 h血糖及糖化血红蛋白	5.00	4.90
	7.患者空腹血糖≥16.7 mmol/L时，评估是否接受院前内分泌科治疗，控制血糖<10.0 mmol/L后再入院；建议患者术前糖化血红蛋白≤6.5%，空腹血糖≤6.1 mmol/L，餐后2 h血糖≤7.8 mmol/L；对于因糖尿病相关并发症或广泛合并症的患者，以及无法安全达到血糖较低指标的患者，建议术前糖化血红蛋白控制在7%~8%；对于术前糖化血红蛋白≥8%的患者，应结合临床实际情况谨慎选择手术^[27,31]	5.00	4.98

项目	具体内容	第1轮投票结果（分）	第2轮投票结果（分）
入院前预约床位	1.根据患者需求预约并安排床位	5.00	4.60
	2.建立患者个人专属微信沟通群，以利于住院期间交流及出院后随访	4.60	4.88

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