Greenville Hospital System University Medical Center, University of South Carolina School of Medicine, Greenville, Greenville, South Carolina 29607, USA.
Surg Obes Relat Dis. 2013 Jan-Feb;9(1):32-9. doi: 10.1016/j.soard.2011.09.002. Epub 2011 Sep 16.
Morbid obesity is associated with the development of cardiovascular and cerebrovascular disease. Several studies have shown that bariatric surgery results in risk factor reduction; however, studies correlating bariatric surgery to the reduced rates of myocardial infarction, stroke, or death have been limited.
We conducted a large retrospective cohort study of bariatric (BAR) surgical patients (n = 4747) and morbidly obese orthopedic (n = 3066) and gastrointestinal (n = 1327) surgical controls. Data were obtained for all patients aged 40-79 years, from 1996 to 2008, with a diagnosis code of morbid obesity and a primary surgical procedure of interest. The data sources were the statewide South Carolina Universal Billing Code of 1992 inpatient hospitalization database and death records. The primary study outcome was the time-to-occurrence of the composite outcome of postoperative myocardial infarction, stroke, or death (all-cause).
The 5-year Kaplan-Meier life table estimate of the composite index of event-free survival in the BAR, orthopedic, and gastrointestinal cohorts was 84.8%, 72.8%, and 65.8%, respectively. After adjusting for baseline differences and potential confounders, the Cox proportional hazards ratio was .72 (95% confidence interval .58-.89) for BAR versus orthopedic and .48 (95% confidence interval .39-.61) for BAR versus gastrointestinal.
Bariatric surgery was significantly associated with a 25-50% risk reduction in the composite index of postoperative myocardial infarction, stroke, or death compared with other morbidly obese surgical patients in South Carolina.
病态肥胖与心血管和脑血管疾病的发展有关。几项研究表明，减重手术可降低风险因素；然而，将减重手术与心肌梗死、中风或死亡发生率降低相关联的研究有限。
我们对接受过减重（BAR）手术的患者（n = 4747 人）和病态肥胖骨科（n = 3066 人）和胃肠道（n = 1327 人）手术的对照组患者进行了一项大型回顾性队列研究。1996 年至 2008 年，所有年龄在 40-79 岁之间的患者都获得了数据，这些患者有病态肥胖的诊断代码和主要手术程序。数据来源是 1992 年全州范围内的南卡罗来纳州通用计费代码住院数据库和死亡记录。主要研究结果是术后心肌梗死、中风或死亡（全因）复合结局的发生时间。
BAR、骨科和胃肠道队列的 5 年 Kaplan-Meier 生存表估计无事件复合指数的存活率分别为 84.8%、72.8%和 65.8%。在调整基线差异和潜在混杂因素后，BAR 与骨科的 Cox 比例风险比为.72（95%置信区间.58-.89），BAR 与胃肠道的 Cox 比例风险比为.48（95%置信区间.39-.61）。
与南卡罗来纳州其他病态肥胖手术患者相比，减重手术与术后心肌梗死、中风或死亡复合指数降低 25-50%的风险显著相关。
