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Careful selection of bariatric patients is critical for successful outcomes. In 1991, the NIH first established patient selection guidelines; however, some surgeons operate on individuals outside of these criteria, i.e., extreme age groups. We developed appropriateness criteria for the spectrum of patient characteristics including age, BMI, and severity of eight obesity-related comorbidities. Candidate criteria were developed using combinations of patient characteristics including BMI: ≥40 kg/m2, 35–39, 32–34, 30–31, <30; age: 12–18, 19–55, 56–64, 65+ years old; and comorbidities: prediabetes, diabetes, hypertension, dyslipidemia, sleep apnea, venous stasis disease, chronic joint pain, and gastroesophageal reflux (plus severity level). Criteria were formally validated on their appropriateness of whether the benefits of surgery clearly outweighed the risks, by an expert panel using the RAND/UCLA modified Delphi method. Nearly all comorbidity severity criteria for patients with BMI ≥40 kg/m2 or BMI = 35–39 kg/m2 in intermediate age groups were found to be appropriate for surgery. In contrast, patients in the extreme age categories were considered appropriate surgical candidates under fewer conditions, primarily the more severe comorbidities, such as diabetes and hypertension. For patients with a BMI of 32–34, only the most severe category of diabetes (Hgb A1c >9, on maximal medical therapy), is an appropriate criterion for those aged 19–64, whereas many mild to moderate severity comorbidity categories are “inappropriate.” There is overwhelming agreement among the panelists that the current evidence does not support performing bariatric surgery in lower BMI individuals (BMI <32). This is the first development of appropriateness criteria for bariatric surgery that includes severity categories of comorbidities. Only for the most severe degrees of comorbidities were adolescent and elderly patients deemed appropriate for surgery. Patient selection for bariatric procedures should include consideration of both patient age and comorbidity severity.Obesity (2009) 17 8, 1521–1527. doi:10.1038/oby.2009.78 [ABSTRACT FROM AUTHOR]

The article presents a literary review of available evidence for quality indicators (QI) that can be used to assess the screening and treatment of colorectal cancer in vulnerable elders (VE). The review included 138 articles about colorectal cancer. A description of the 21 QI which were judged by an expert panel as valid is presented, including comorbidity, pretreatment computed tomography and surgical outcome discussion. The supporting evidences for each QI are also explained.

The article presents a literary review of available evidence for quality indicators (QI) that can be used to assess the general medical care of hospitalized vulnerable elders (VE). The review included 485 articles about the hospital care and surgery of VE and their susceptibility to nosocomial pneumonia. A description of the 30 QI which were judged by an expert panel as valid is presented, including general hospital care, endocarditis prophylaxis and catheterization. The supporting evidences for each QI are also explained.