Digestive, Colorectal and Minimal Invasive Surgery, University of Torino, Corso A M Dogliotti 14, Turin, Italy.
Ann Surg. 2012 Nov;256(5):724-8; discussion 728-9. doi: 10.1097/SLA.0b013e3182734113.
: To analyze the potential effects of preoperative age on postoperative weight loss in patients who underwent Roux-en-Y gastric bypass (RYGBP) with long-term follow-up data.
: The reasons for individual differences in surgically induced weight loss are not completely understood. To date, there are no available studies specifically aimed at analyzing the effects of age on weight loss in patients undergoing the same operation and with long-term follow-up data.
: Retrospective analysis of prospectively collected data for all patients who underwent RYGBP between 2006 and 2010. To evaluate weight loss, we used preoperative and follow-up body mass index (BMI), analyzed by the mixed-effects linear model for repeated measures. To evaluate age effects, patients were classified in quartiles (≤35 years, 36-42 years, 43-51 years, ≥52 years).
: A total of 489 patients entered the study; preoperatively, the younger group showed a significantly higher BMI (mean BMI: 48.2 in patients aged ≤35 years, 46.9 in 36-42 years, 45.5 in 43-51 years, 45.7 in ≥52 years, P = 0.014) and a higher percentage of super-obesity (41.6% among patients aged ≤35 years, 28.1% among 36-42 years, 27.6% among 43-51 years, 28.3% among ≥ 52 years, P = 0.047). In spite of this, younger patients experienced a significantly greater and prolonged BMI decrease during the entire follow-up period and the BMI trend over time resulted significantly modified according to age quartiles (P = 0.036).
: This study provides a new prognostic factor in bariatric surgery: patient age. Because advanced age represents a risk factor for complications and mortality, and given that bariatric surgery may not be as effective in older patients compared to younger subjects, we believe that surgical indications in patients older than 50 years should be carefully weighed up.
分析术前年龄对接受 Roux-en-Y 胃旁路术（RYGBP）且具有长期随访数据的患者术后体重减轻的潜在影响。
个体间手术诱导体重减轻的差异原因尚不完全清楚。迄今为止，尚无专门针对分析相同手术且具有长期随访数据的患者中年龄对体重减轻影响的研究。
回顾性分析 2006 年至 2010 年间接受 RYGBP 的所有患者前瞻性收集的数据。为了评估体重减轻，我们使用术前和随访时的身体质量指数（BMI），通过重复测量的混合效应线性模型进行分析。为了评估年龄的影响，将患者分为四分位数（≤35 岁、36-42 岁、43-51 岁、≥52 岁）。
共有 489 名患者入组研究；年轻组术前 BMI 显著较高（年轻组患者平均 BMI：≤35 岁者为 48.2、36-42 岁者为 46.9、43-51 岁者为 45.5、≥52 岁者为 45.7，P=0.014），且超肥胖比例较高（≤35 岁者为 41.6%、36-42 岁者为 28.1%、43-51 岁者为 27.6%、≥52 岁者为 28.3%，P=0.047）。尽管如此，年轻患者在整个随访期间 BMI 下降更为显著且持久，且 BMI 随时间的趋势根据年龄四分位数发生显著改变（P=0.036）。
本研究提供了肥胖症手术中的一个新的预后因素：患者年龄。由于高龄代表并发症和死亡率的风险因素，且与年轻患者相比，肥胖症手术对老年患者的效果可能不佳，我们认为 50 岁以上患者的手术适应证应慎重考虑。
