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Narrative

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Source1

{
  "resourceType": "Evidence",
  "id": "104157",
  "meta": {
    "versionId": "14",
    "lastUpdated": "2026-01-06T23:40:31.739Z",
    "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/104157",
  "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": "104157",
      "assigner": {
        "display": "Computable Publishing LLC"
      }
    }
  ],
  "name": "ComparativeEvidence_Bypass_surgery_effects_on_Additional_GI_surgical_procedure_in_JAMA_2018_Norwegian_cohort_study",
  "title": "ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study",
  "citeAs": "ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study [Database Entry: FHIR Evidence Resource]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104157. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104157. Computable resource at: https://fevir.net/resources/Evidence/104157#json.",
  "status": "active",
  "date": "2022-09-19T21:15:43.661Z",
  "author": [
    {
      "name": "Brian S. Alper"
    }
  ],
  "publisher": "Computable Publishing LLC",
  "contact": [
    {
      "telecom": [
        {
          "system": "email",
          "value": "support@computablepublishing.com"
        }
      ]
    }
  ],
  "useContext": [
    {
      "code": {
        "system": "https://fevir.net/resources/CodeSystem/179423",
        "code": "evidence-communication",
        "display": "Evidence Communication"
      },
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://fevir.net/resources/CodeSystem/179423",
            "code": "ComparativeEvidence",
            "display": "ComparativeEvidence"
          }
        ]
      }
    },
    {
      "code": {
        "system": "https://fevir.net/resources/CodeSystem/179423",
        "code": "evidence-communication",
        "display": "Evidence Communication"
      },
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://fevir.net/resources/CodeSystem/179423",
            "code": "SingleStudyEvidence",
            "display": "SingleStudyEvidence"
          }
        ]
      }
    }
  ],
  "copyright": "https://creativecommons.org/licenses/by-nc-sa/4.0/",
  "relatesTo": [
    {
      "type": "derived-from",
      "targetUri": "https://jamanetwork.com/journals/jama/fullarticle/2669729"
    }
  ],
  "description": "Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]).",
  "assertion": "Compared with specialized medical treatment, bariatric surgery appears to increase the rate of additional gastrointestinal surgical procedures.",
  "variableDefinition": [
    {
      "description": "Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included).",
      "variableRole": "population",
      "observed": {
        "reference": "Group/178427",
        "type": "Group",
        "display": "StudyGroup: Severely Obese Adults 2018 Norwegian Cohort"
      }
    },
    {
      "description": "bariatric surgery vs. specialized medical treatment without bariatric surgery",
      "variableRole": "exposure",
      "comparatorCategory": "no bariatric surgery",
      "observed": {
        "reference": "EvidenceVariable/172427",
        "type": "EvidenceVariable",
        "display": "GroupAssignment: Bariatric Surgery vs. no bariatric surgery"
      }
    },
    {
      "description": "Additional GI surgical procedure",
      "variableRole": "outcome",
      "observed": {
        "reference": "EvidenceVariable/104120",
        "type": "EvidenceVariable",
        "display": "OutcomeVariable: Additional GI surgical procedure"
      }
    }
  ],
  "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:01028",
          "display": "longitudinal data collection"
        }
      ]
    }
  ],
  "statistic": [
    {
      "description": "Relative risk 2.0; 95% CI 1.7 to 2.4",
      "note": [
        {
          "text": "Result observed without bariatric surgery was 15.5%, result observed with bariatric surgery was 31.3%"
        }
      ],
      "statisticType": {
        "coding": [
          {
            "system": "https://fevir.net/sevco",
            "code": "STATO:0000245",
            "display": "risk ratio"
          }
        ]
      },
      "quantity": {
        "value": 2
      },
      "sampleSize": {
        "numberOfStudies": 1,
        "numberOfParticipants": 1888,
        "knownDataCount": 1888
      },
      "attributeEstimate": [
        {
          "description": "95% CI 1.7 to 2.4",
          "type": {
            "coding": [
              {
                "system": "https://fevir.net/sevco",
                "code": "STATO:0000196",
                "display": "confidence interval"
              }
            ]
          },
          "level": 0.95,
          "range": {
            "low": {
              "value": 1.7
            },
            "high": {
              "value": 2.4
            }
          }
        }
      ]
    }
  ],
  "certainty": [
    {
      "description": "rated down 2 levels due to observational study, rated up 1 level for large effect size",
      "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": "moderate",
            "display": "Moderate quality"
          }
        ]
      }
    }
  ]
}