创作:szx 审核:szx 2019年08月10日
  • 纳入8966名接受过减肥手术(4955名胃旁路术、4011名袖状胃减容术)及8966名未接受过减肥手术的肥胖患者;
  • 平均随访6.8年后,接受过胃旁路术及袖状胃减容术的患者的死亡率均显著低于相应的对照组;
  • 接受过胃旁路术及袖状胃减容术的患者的营养失调、无需侵入性治疗的胃肠道症状、侵入性胃肠道手术或内镜检查的风险均显著高于相应的对照组;
  • 在精神疾病的风险方面,2个减肥手术组与相应对照组均无显著关联。
The Lancet Diabetes and Endocrinology上发表的一项队列研究结果,对近1万名接受过减肥手术的肥胖患者进行了平均为期7年的随访,发现手术可能增加多种胃肠道相关不良事件的风险。

Long-term adverse events after sleeve gastrectomy or gastric bypass: a 7-year nationwide, observational, population-based, cohort study



2019-08-02, Article

Abstract & Authors:展开

Background: Concerns are rising about the late adverse events following gastric bypass and sleeve gastrectomy. We aimed to assess, over a 7-year period, the late adverse events after gastric bypass and sleeve gastrectomy compared with matched control groups.
Methods: In this nationwide, observational, population-based, cohort study, we used data extracted from the French National Health Insurance (Système National des Données de Santé) database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009, except those who had undergone bariatric surgery in the previous 4 years before inclusion, were matched with control patients with obesity in terms of age, sex, BMI category, baseline antidiabetic therapy, and baseline insulin therapy. Exclusion criteria for the control group included cancer, pregnancy, chronic infectious disease, serious acute or chronic disease in 2008–09, or previous (2005–09) or forthcoming (2010–11) bariatric surgery. The incidence rate was calculated for each type of adverse event leading to inpatient hospital admission over a 7-year period; incidence rate ratios (with 95% CIs) were computed to compare the rate of complications among the bariatric surgery and control groups. Risks of complications during follow-up were compared using Cox proportional-hazards regression analyses. Data were analysed according to the intention-to-treat methodology.
Findings: From Jan 1, 2009, to Dec 31, 2009, 8966 patients who underwent bariatric surgery (7359 [82%] women; mean age 40·4 years [SD 11·3]) and 8966 matched controls (7359 [82%] women; mean age 40·9 years [11·4]) were included in analyses 4955 (55%) off 8966 patients in the bariatric surgery group had a primary gastric bypass and 4011 (45%) patients had sleeve gastrectomy. With a mean follow-up of 6·8 years (SD 0·2), mortality was lower in the gastric bypass group than in its control group (hazard ratio 0·64 [95% CI 0·52–0·78]; p<0·0001) and in the sleeve gastrectomy group than in its control group (0·38 [0·29–0·50]; p<0·0001). The gastric bypass and sleeve gastrectomy groups had higher risk than did their control groups for invasive gastrointestinal surgery or endoscopy (incidence rate ratio 2·4 [95% CI 2·1–2·7], p<0·0001, for gastric bypass vs control and 1·5 [1·3–1·7], p<0·0001, for sleeve gastrectomy vs control); for gastrointestinal disorders not leading to invasive procedures (1·9 [1·7–2·1]), p<0·0001, for gastric bypass vs control and 1·2 [1·1–1·4], p<0·0001, for sleeve gastrectomy vs control); and for nutritional disorders (4·9 [3·8–6·4], p<0·0001, for gastric bypass vs control and 1·8 [1·3–2·5], p<0·0001, for sleeve gastrectomy vs control). For psychiatric disorders, there was no significant association (1·1 [0·9–1·4], p=0·190, for gastric bypass vs control and 1·1 [0·8–1·3], p=0·645, for sleeve gastrectomy vs control), except for gastric bypass and alcohol dependence (1·8 [1·1–2·8], p=0·0124).
Interpretation: Despite lower 7-year mortality, patients undergoing gastric bypass or sleeve gastrectomy had higher risk of hospital admission at least once for late adverse events, except for psychiatric disorders, than did control patients, with a higher risk observed after gastric bypass than with sleeve gastrectomy.

First Authors:
Jérémie Thereaux

Correspondence Authors:
Jérémie Thereaux

All Authors:
Jérémie Thereaux,Thomas Lesuffleur,Sébastien Czernichow,Arnaud Basdevant,Simon Msika,David Nocca,Bertrand Millat,Anne Fagot-Campagna