Generated Narrative: EvidenceVariable

identifier: FEvIR Object Identifier: 32140

title: RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)

shortTitle: Recommend bariatric surgery if BMI 35 or higher

status: active

publisher: Computable Publishing LLC

contact: support@computablepublishing.com

description: Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.

copyright: https://creativecommons.org/licenses/by-nc-sa/4.0/

effectivePeriod: 2021-01 --> (ongoing)

author: Brian S. Alper:

actual: false

characteristic

description: Adult.

exclude: false

DefinitionByTypeAndValues

-	Type	Value[x]
*	Age (SNOMED CT#397669002)	>=18 years (Details: UCUM code a = 'a')

characteristic

description: Diagnosed with type 2 diabetes.

exclude: false

DefinitionByTypeAndValues

-	Type	Value[x]
*	Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")	Diabetes mellitus type 2 (disorder) (SNOMED CT#44054006)

characteristic

description: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

definitionByCombination

code: any-of

characteristic

description: Body Mass Index (BMI) ≥ 40.0 kg/m2

exclude: false

characteristic

description: BMI ≥ 37.5 kg/m2 in Asian Americans

characteristic

description: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

characteristic

description: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

characteristic

description: Cardiovascular event (myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke) in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionByCombination

code: any-of

characteristic

description: acute coronary heart disease (a value set covering many forms)

characteristic

description: coronary artery angioplasty or bypass

characteristic

description: stroke

TimeFromEvents

-	Description	Note	Range
*	in the past six months	occurrence within the range is equivalent to 'in the past six months'	-6-0 months

characteristic

description: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease.

note: This may be possible to encode as presence of Disease(disorder) without 'in remission', placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease. ()

characteristic

description: Cardiac stress test indicating that surgery or IMM would not be safe.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: Cardiac stress test indicating that surgery or IMM would not be safe. ()

characteristic

description: Pulmonary embolus in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-	Type	Value[x]
*	Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")	Pulmonary embolism (disorder) (SNOMED CT#59282003)

TimeFromEvents

-	Description	Note	Range
*	in the past six months	occurrence within the range is equivalent to 'in the past six months'	-6-0 months

characteristic

description: Thrombophlebitis in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-	Type	Value[x]
*	Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")	Thrombophlebitis (disorder) (SNOMED CT#64156001)

TimeFromEvents

-	Description	Note	Range
*	in the past six months	occurrence within the range is equivalent to 'in the past six months'	-6-0 months

characteristic

description: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years.

note: This combination logic fails if the patient has both a basal cell skin cancer or cancer in situ and a cancer of another kind., placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionByCombination

code: all-of

characteristic

description: Cancer of any kind

exclude: false

characteristic

description: (except basal cell skin cancer)

exclude: true

characteristic

description: (except cancer in situ)

exclude: true

characteristic

description: unless documented to be disease-free for five years

exclude: true

definitionCodeableConcept: No evidence of cancer found (situation) (SNOMED CT#395100000)

characteristic

description: History of coagulopathy

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: history of coagulopathy ()

characteristic

description: Significant anemia (hemoglobin 1.0 g or more below normal range)

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-	Type	Value[x]	Offset
*	Hemoglobin [Mass/volume] in Blood (LOINC#718-7)	<=-1 g/dL (Details: UCUM code g/dL = 'g/dL')	Lower Normal Limit (CharacteristicOffset#LNL)

characteristic

description: Serum creatinine ≥ 1.5 mg/dl

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-	Type	Value[x]
*	Creatinine [Mass/volume] in Serum or Plasma (LOINC#2160-0)	>=1.5 mg/dl (Details: UCUM code mg/dL = 'mg/dL')