Bruschi Kelles S M, Diniz M F H S, Machado C J, Barreto S M
Centro de Pós Graduação, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Braz J Med Biol Res. 2014 Jul;47(7):617-25. doi: 10.1590/1414-431x20143578. Epub 2014 Jun 13.
The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m(2). The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m(2), and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m(2), and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.
肥胖症在全球范围内已发展到流行程度。成千上万的病态肥胖个体接受减肥手术以实现持续减重；然而，该手术的中长期效果仍不明确。我们的目标是估计10年死亡率，并确定接受减肥手术的年轻病态肥胖成年人的死亡相关风险因素。对2001年至2010年期间由一家保险公司承保的所有接受开放式Roux-en-Y胃旁路手术的患者进行分析，以确定手术时存在的风险因素与手术相关及非手术相关死亡之间的可能关联。在纳入研究的4344例患者中，79%为女性，中位年龄为34.9岁，中位体重指数（BMI）为42kg/m²。30天和10年死亡率分别为0.55%和3.34%，53.7%的死亡与减肥手术后的早期或晚期并发症相关。其中，42.7%的死亡归因于败血症，24.3%归因于心血管并发症。男性、年龄≥50岁、BMI≥50kg/m²和高血压显著增加了所有死亡的风险（P<0.001）。年龄≥50岁、BMI≥50kg/m²和外科医生经验不足增加了手术相关原因导致的死亡风险。男性和年龄≥50岁是与非手术相关死亡导致的死亡率增加相关的因素。减肥手术后的总体死亡风险相当低，且一半的死亡与手术相关。老年患者和超级肥胖患者手术相关死亡的风险更高，经验不足的外科医生所做手术的患者也是如此。
