Santry Heena P, Gillen Daniel L, Lauderdale Diane S
Department of Surgery, University of Chicago, Chicago, Ill, USA.
JAMA. 2005 Oct 19;294(15):1909-17. doi: 10.1001/jama.294.15.1909.
The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity.
To examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States.
DESIGN, SETTING, AND PATIENTS: The Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates.
Trends in bariatric surgical procedures, patient characteristics, and complications.
The estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002 (P<.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P<.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low.
These findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.
病态肥胖症患病率的不断上升及其相关的社会人口统计学差异是严重的公共卫生问题。与针对病态肥胖症的行为和药物干预措施相比，减肥手术能实现更大幅度且更持久的体重减轻。
研究1998年至2003年美国择期减肥手术的趋势、患者特征及住院并发症情况。
设计、研究地点与患者：利用全国住院患者样本，通过国际疾病分类第九版中前肠手术代码（确诊为肥胖症）或肥胖症手术的诊断相关组代码，识别出1998 - 2002年的减肥手术入院病例（并获取了2003年12个州的初步数据）。确定了手术、患者特征及调整后并发症发生率的年度估计值和趋势。
减肥手术的趋势、患者特征及并发症。
减肥手术的估计例数从1998年的13365例增至2002年的72177例（P <.001）。根据州一级的初步数据（1998 - 2003年），预计2003年减肥手术例数将达102794例。胃旁路手术占所有减肥手术的80%以上。1998年至2002年，女性比例（从81%增至84%；P =.003）、有私人保险的患者比例（从75%增至83%；P =.001）、来自年家庭收入最高邮政编码区域的患者比例（从32%增至60%，P <.001）以及年龄在50至64岁的患者比例（从15%增至24%；P <.001）均呈上升趋势。住院时间从1998年的4.5天降至2002年的3.3天（P <.001）。调整后的住院死亡率在0.1%至0.2%之间。手术并发症意外再次手术率在6%至9%之间，肺部并发症发生率在4%至7%之间。其他住院并发症发生率较低。
这些研究结果表明，1998年至2003年减肥手术的应用大幅增加，而住院并发症发生率保持稳定，住院时间缩短。然而，这些手术应用方面的差异，尤其是女性、有私人保险者以及较富裕邮政编码区域人群中使用比例过高且不断增加的情况，应进一步探究。
