基于人群的减重计划中登记的、接受医学管理和手术治疗的等待名单患者的体重减轻和结局：前瞻性队列研究。

Weight loss and outcomes in wait-listed, medically managed, and surgically treated patients enrolled in a population-based Bariatric program: prospective cohort study.

机构信息

*Department of Medicine, University of Alberta †Alberta Diabetes Institute ‡Department of Surgery and CAMIS (Center for the Advancement of Minimally Invasive Surgery), Royal Alexandra Hospital §Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.

出版信息

Med Care. 2014 Mar;52(3):208-15. doi: 10.1097/MLR.0000000000000070.

DOI:10.1097/MLR.0000000000000070

PMID:24374423

Abstract

BACKGROUND

Multidisciplinary bariatric care is increasingly being delivered in Canada within publicly funded regional programs. Demand is high, wait lists are long, and clinical effectiveness is unknown.

OBJECTIVE

To examine the "real-world" outcomes associated with a publicly funded, population-based regional bariatric (medical and surgical) program.

RESEARCH DESIGN

Prospective observational cohort.

SUBJECTS

Five hundred consecutive patients (150 wait-listed, 200 medically treated, 150 surgically treated) from the Edmonton Weight Wise program were enrolled.

MEASURES

The primary outcome was weight change (kg). Between-group changes were analyzed using multivariable regression adjusted for age, sex, and baseline weight and "last-observation-carried-forward" was used for missing data. Subjects transitioning between groups (wait-list to medical or medical to surgery) were censored when crossing over.

RESULTS

At baseline, mean age was 43.7 ± 9.6 years, mean body mass index was 47.9 ± 8.1 kg/m, and 88% were female. A total of 412 subjects (82%) completed 2-year follow-up and 143 (29%) subjects crossed over to the next treatment phase. Absolute and relative (% of baseline) mean weight reductions were 1.5 ± 8.5 kg (0.9 ± 6.1%) for wait-listed, 4.1 ± 11.6 kg (2.8 ± 8.1%) for medically treated, and 22.0 ± 19.7 kg (16.3 ± 13.5%) for surgically treated (P<0.001) subjects. For surgery, weight reductions were 7.0 ± 9.7 kg (5.8 ± 7.9%) with banding, 21.4 ± 16.0 kg (16.4 ± 11.6%) with sleeve gastrectomy, and 36.6 ± 19.5 kg (26.1 ± 12.2%) with gastric bypass (P<0.001). Rates of hypertension, diabetes, and dyslipidemia decreased to a significantly greater degree with surgery than medical management (P<0.001) and stayed the same or increased in wait-listed subjects.

CONCLUSIONS

Population-based bariatric care, particularly bariatric surgery, was clinically effective. Weight and cardiometabolic risk was relatively stable wait-listed patients receiving "usual care."

摘要

背景

在加拿大，多学科减重护理越来越多地在公共资助的区域项目中提供。需求很高，等待名单很长，临床效果未知。

目的

研究公共资助的基于人群的区域性减重（医疗和手术）计划相关的“真实世界”结果。

研究设计

前瞻性观察队列。

研究对象

从埃德蒙顿 Weight Wise 计划中招募了 500 名连续患者（150 名候补，200 名接受药物治疗，150 名接受手术治疗）。

测量

主要结果是体重变化（kg）。使用多变量回归分析了组间变化，并根据年龄、性别和基线体重进行了调整，对于缺失数据采用“最后观察向前结转”方法。当跨越时，在从候补组过渡到医疗组或从医疗组过渡到手术组的患者中进行了删失。

结果

基线时，平均年龄为 43.7 ± 9.6 岁，平均体重指数为 47.9 ± 8.1 kg/m，88%为女性。共有 412 名患者（82%）完成了 2 年随访，143 名患者（29%）跨越到下一治疗阶段。候补组的绝对和相对（基线的%）平均体重减轻量分别为 1.5 ± 8.5 kg（0.9 ± 6.1%），药物治疗组为 4.1 ± 11.6 kg（2.8 ± 8.1%），手术治疗组为 22.0 ± 19.7 kg（16.3 ± 13.5%）（P<0.001）。对于手术组，减重分别为带囊带的 7.0 ± 9.7 kg（5.8 ± 7.9%），袖状胃切除术的 21.4 ± 16.0 kg（16.4 ± 11.6%）和胃旁路手术的 36.6 ± 19.5 kg（26.1 ± 12.2%）（P<0.001）。与药物治疗相比，手术治疗显著降低了高血压、糖尿病和血脂异常的发生率（P<0.001），而候补组的发生率保持不变或增加。