Courcoulas Anita P, Christian Nicholas J, O'Rourke Robert W, Dakin Greg, Patchen Dellinger E, Flum David R, Melissa Kalarchian Ph D, Mitchell James E, Patterson Emma, Pomp Alfons, Pories Walter J, Spaniolas Konstantinos, Steffen Kristine, Wolfe Bruce M, Belle Steven H
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1109-18. doi: 10.1016/j.soard.2015.01.011. Epub 2015 Jan 23.
Limited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change.
Ten hospitals in 6 geographically diverse clinical centers in the United States.
Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively.
The median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%-38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%-23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m(2) for RYGB and 44 kg/m(2) for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band circumference had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex.
Few baseline variables were associated with 3-year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual's chance of a successful weight loss outcome after bariatric surgery.
NCT00465829, ClinicalTrials.gov.
依据术前因素预测减肥手术后体重减轻成功或失败的数据有限。减肥手术后体重变化存在显著差异，人们对确定可能导致这些差异的术前因素兴趣浓厚。本报告评估了一组全面的基线因素与3年体重变化之间的关联。
美国6个地理位置不同的临床中心的10家医院。
2006年至2009年期间，招募了作为参与手术的临床护理一部分而接受首次减肥手术的成年人。参与者通过对接受Roux-en-Y胃旁路术（RYGB）和腹腔镜可调节胃束带术（LAGB）的个体进行100多个术前和手术参数的标准化详细数据收集来完成研究评估。术后3年测量体重。将RYGB或LAGB从基线到3年的体重变化百分比作为连续和二分结果进行分析，RYGB的切点为25%，LAGB的切点为10%。多变量线性和逻辑回归模型分别用于确定连续和分类结果的独立基线预测因素。
RYGB组（n = 1513）参与者术后3年的体重减轻中位数为基线体重的31.5%（四分位间距：24.6% - 38.4%；范围，体重减轻59.2%至增加0.9%），LAGB组（n = 509）参与者为16.0%（四分位间距：8.1% - 23.1%；范围，体重减轻56.1%至增加12.5%）。RYGB组的年龄中位数为46岁，LAGB组为48岁；RYGB组80%的参与者和LAGB组75%的参与者为女性；RYGB组的基线体重指数（BMI）中位数为46kg/m²，LAGB组为44kg/m²。对于RYGB，黑人参与者比白人少减重2.7%，基线时有糖尿病的参与者在第3年的体重减轻比基线时无糖尿病的参与者少3.7%。肾功能异常以及当前或近期吸烟的RYGB参与者在体重变化方面存在虽小但具有统计学意义的差异。对于LAGB参与者，在调整BMI和性别后，束带周长较大的参与者体重减轻少于10%的几率高75%。
几乎没有基线变量与3年体重变化相关，且影响较小。这些结果表明，基线变量对个体减肥手术成功减重结果的预测价值有限。
NCT00465829，ClinicalTrials.gov。
