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Source1

{
  "resourceType": "Evidence",
  "id": "104098",
  "meta": {
    "versionId": "16",
    "lastUpdated": "2026-01-07T19:14:15.016Z",
    "profile": [
      "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence",
      "http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence"
    ]
  },
  "language": "en",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/ebm/StructureDefinition/artifact-publication-status",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/cited-artifact-status-type",
            "code": "active",
            "display": "Active"
          }
        ]
      }
    }
  ],
  "url": "https://fevir.net/resources/Evidence/104098",
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "ACSN",
            "display": "Accession ID"
          }
        ],
        "text": "FEvIR Object Identifier"
      },
      "system": "https://fevir.net/FOI",
      "value": "104098",
      "assigner": {
        "display": "Computable Publishing LLC"
      }
    }
  ],
  "name": "ComparativeEvidence_Bypass_surgery_effects_on_Myocardial_infarction_or_stroke_in_Swedish_Obese_Subjects_SOS_study",
  "title": "ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study",
  "citeAs": "ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study [Database Entry: FHIR Evidence Resource]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104098. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104098. Computable resource at: https://fevir.net/resources/Evidence/104098#json.",
  "status": "active",
  "date": "2022-09-19T21:15:57.338Z",
  "author": [
    {
      "name": "Brian S. Alper"
    }
  ],
  "publisher": "Computable Publishing LLC",
  "contact": [
    {
      "telecom": [
        {
          "system": "email",
          "value": "support@computablepublishing.com"
        }
      ]
    }
  ],
  "copyright": "https://creativecommons.org/licenses/by-nc-sa/4.0/",
  "relatesTo": [
    {
      "type": "derived-from",
      "targetUri": "https://jamanetwork.com/journals/jama/fullarticle/1103994"
    }
  ],
  "description": "Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001). -- Extrapolated from this data the outcome of Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)",
  "assertion": "Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.",
  "variableDefinition": [
    {
      "description": "Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women.  All in Sweden.",
      "variableRole": "population"
    },
    {
      "description": "bariatric surgery vs. usual care without bariatric surgery",
      "variableRole": "exposure",
      "comparatorCategory": "no bariatric surgery",
      "intended": {
        "reference": "EvidenceVariable/172427",
        "type": "EvidenceVariable",
        "display": "GroupAssignment: Bariatric Surgery vs. no bariatric surgery"
      }
    },
    {
      "description": "nonfatal myocardial infarction or stroke",
      "variableRole": "outcome",
      "observed": {
        "reference": "EvidenceVariable/104097",
        "type": "EvidenceVariable",
        "display": "OutcomeVariable: Nonfatal myocardial infarction or stroke"
      }
    }
  ],
  "synthesisType": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/synthesis-type",
          "code": "NotApplicable",
          "display": "not applicable"
        }
      ]
    }
  ],
  "studyDesign": [
    {
      "coding": [
        {
          "system": "https://fevir.net/sevco",
          "code": "SEVCO:01002",
          "display": "observational research"
        }
      ]
    },
    {
      "coding": [
        {
          "system": "https://fevir.net/sevco",
          "code": "SEVCO:01011",
          "display": "parallel cohort design"
        }
      ]
    },
    {
      "coding": [
        {
          "system": "https://fevir.net/sevco",
          "code": "SEVCO:01014",
          "display": "matching for comparison"
        }
      ]
    },
    {
      "coding": [
        {
          "system": "https://fevir.net/sevco",
          "code": "SEVCO:01028",
          "display": "longitudinal data collection"
        }
      ]
    }
  ],
  "statistic": [
    {
      "description": "Hazard ratio, adjusted 0.67; 95% CI 0.54 to 0.83",
      "note": [
        {
          "text": "The event rates are calculated from the reported total (fatal and nonfatal events) minus the fatal events. Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)"
        }
      ],
      "statisticType": {
        "coding": [
          {
            "system": "https://fevir.net/sevco",
            "code": "STATO:0000677",
            "display": "hazard ratio"
          }
        ]
      },
      "quantity": {
        "value": 0.67
      },
      "numberAffected": 359,
      "sampleSize": {
        "numberOfParticipants": 4047,
        "knownDataCount": 4047
      },
      "attributeEstimate": [
        {
          "description": "95% CI 0.54 to 0.83",
          "type": {
            "coding": [
              {
                "system": "https://fevir.net/sevco",
                "code": "STATO:0000196",
                "display": "confidence interval"
              }
            ]
          },
          "level": 0.95,
          "range": {
            "low": {
              "value": 0.54
            },
            "high": {
              "value": 0.83
            }
          }
        }
      ],
      "modelCharacteristic": [
        {
          "code": {
            "text": "Adjusted analysis - Adjustment for covariates"
          }
        }
      ]
    }
  ],
  "certainty": [
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/certainty-type",
            "code": "Overall",
            "display": "Overall certainty"
          }
        ]
      },
      "rating": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/certainty-rating",
            "code": "low",
            "display": "Low quality"
          }
        ]
      }
    }
  ]
}