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Source1

{
  "resourceType": "Evidence",
  "id": "179586",
  "meta": {
    "versionId": "14",
    "lastUpdated": "2026-01-07T11:26:17.633Z",
    "profile": [
      "http://hl7.org/fhir/uv/ebm/StructureDefinition/net-effect-contribution"
    ]
  },
  "language": "en",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "url": "https://fevir.net/resources/Evidence/179586",
  "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": "179586",
      "assigner": {
        "display": "Computable Publishing LLC"
      }
    }
  ],
  "name": "NetEffectContribution_for_ComparativeEvidence_All_cause_mortality_effect_of_bariatric_surgery_in_2022_meta_analysis",
  "title": "NetEffectContribution for ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis",
  "citeAs": "NetEffectContribution for ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis [Database Entry: FHIR Evidence Resource]. Contributors: Computable Publishing: Net Effect Generator, Brian S. Alper, MD, MSPH [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179586. Revised 2026-01-07. Available at: https://fevir.net/resources/Evidence/179586. Computable resource at: https://fevir.net/resources/Evidence/179586#json.",
  "status": "active",
  "author": [
    {
      "name": "Computable Publishing: Net Effect Generator"
    },
    {
      "name": "Brian S. Alper, MD, MSPH"
    }
  ],
  "publisher": "Computable Publishing LLC",
  "contact": [
    {
      "telecom": [
        {
          "system": "email",
          "value": "support@computablepublishing.com"
        }
      ]
    }
  ],
  "copyright": "https://creativecommons.org/licenses/by-nc-sa/4.0/",
  "description": "This Evidence Resource is referenced in an example for the EBMonFHIR Implementation Guide.",
  "variableDefinition": [
    {
      "description": "obese, adult (age ≥18 years old) patients *NOTE: note.text is used artificially to support the EBMonFHIR Implementation Guide and the following content would more properly be found in a note.text element:* Studies were considered eligible if they were designed to study outcomes in obese patients who underwent a weight-loss surgical intervention in comparison with an age, sex, and BMI matched control group who did not undergo a weight-loss surgical intervention. We searched for randomized controlled trials, prospective or retrospective longitudinal cohort studies, and case–control studies. For the control group, all non-surgical treatment options for obesity (e.g. intensive lifestyle intervention, standard of care, or no specific therapy) were accepted. Studies were excluded if (i) patients were not matched for age, sex, and BMI; (ii) the presence of one or more outcome parameters of interest (e.g. HF, AF, coronary artery disease) was required for inclusion; or (iii) if study groups were not representative in relation to the general population of patients with obesity (e.g. patients could only be included in the presence of a specific comorbidity, for instance, end-stage renal disease). The third criterium did not apply to Type 2 diabetes, thus studies that only included patients with Type 2 diabetes could be eligible for inclusion.",
      "variableRole": "population",
      "intended": {
        "reference": "Group/171819",
        "type": "Group",
        "display": "StudyEligibilityCriteria: Obese patients ≥ 18 years old"
      }
    },
    {
      "description": "comparison groups of bariatric surgery vs. no bariatric surgery *NOTE: note.text is used artificially to support the EBMonFHIR Implementation Guide and the following content would more properly be found in a note.text element:* As the control group (observed reference exposure) was defined differently in each study, the intended reference exposure is described as the absence of the intended exposure (Bariatric Surgery).",
      "variableRole": "exposure",
      "comparatorCategory": "no bariatric surgery",
      "intended": {
        "reference": "EvidenceVariable/172427",
        "type": "EvidenceVariable",
        "display": "GroupAssignment: Bariatric Surgery vs. no bariatric surgery"
      }
    },
    {
      "description": "All-cause mortality *NOTE: note.text is used artificially to support the EBMonFHIR Implementation Guide and the following content would more properly be found in a note.text element:* The observed element can reference an EvidenceVariable Resource that defines the outcome measured through structured characteristics. For example, “Mean difference in HbA1c at 12 months” or “Mean difference in HbA1c at end of study”. The structured characteristics can be references to the Evidence instances for each of the included studies, in which case this is a direct link to the dataset used for analysis. The intended element can reference an EvidenceVariable Resource that expresses the outcome intended for evidence application through structured characteristics. The structured characteristics could be used to express the SR eligibility criteria for study outcomes (as a subset of eligibility criteria for studies).",
      "variableRole": "outcome",
      "observed": {
        "display": "We searched for randomized controlled trials, prospective or retrospective longitudinal cohort studies, and case–control studies. For the control group, all non-surgical treatment options for obesity (e.g. intensive lifestyle intervention, standard of care, or no specific therapy) were accepted. Studies were excluded if (i) patients were not matched for age, sex, and BMI; (ii) the presence of one or more outcome parameters of interest (e.g. HF, AF, coronary artery disease) was required for inclusion; or (iii) if study groups were not representative in relation to the general population of patients with obesity (e.g. patients could only be included in the presence of a specific comorbidity, for instance, end-stage renal disease). The third criterium did not apply to Type 2 diabetes, thus studies that only included patients with Type 2 diabetes could be eligible for inclusion."
      },
      "intended": {
        "reference": "EvidenceVariable/49217",
        "type": "EvidenceVariable",
        "display": "OutcomeVariable: All-cause mortality"
      }
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/uv/ebm/StructureDefinition/relative-outcome-importance",
          "valueReference": {
            "reference": "ArtifactAssessment/423309",
            "type": "ArtifactAssessment",
            "display": "Outcome Importance Rating of DIO: Mortality  for StudyEligibilityCriteria: Eligibility Criteria for Bariatric Surgery Randomized Trial (Diabetes Surgery Study)"
          }
        }
      ],
      "variableRole": "covariate",
      "roleSubtype": {
        "text": "Relative Value Multiplier"
      },
      "observed": {
        "display": "Relative Importance Multiplier"
      }
    }
  ],
  "statistic": [
    {
      "statisticType": {
        "coding": [
          {
            "system": "https://fevir.net/sevco",
            "code": "STATO:0000424",
            "display": "risk difference"
          }
        ]
      },
      "quantity": {
        "value": 213.75
      },
      "attributeEstimate": [
        {
          "type": {
            "coding": [
              {
                "system": "https://fevir.net/sevco",
                "code": "STATO:0000196",
                "display": "confidence interval"
              }
            ]
          },
          "level": 0.95,
          "range": {
            "low": {
              "value": 180.5
            },
            "high": {
              "value": 242.25
            }
          }
        }
      ],
      "modelCharacteristic": [
        {
          "code": {
            "text": "Net effect contribution analysis"
          }
        }
      ]
    }
  ]
}