Weiss Anna C, Parina Ralitza, Horgan Santiago, Talamini Mark, Chang David C, Sandler Bryan
University of California, San Diego, Department of Surgery, San Diego, California.
University of California, San Diego, Department of Surgery, San Diego, California.
Surg Obes Relat Dis. 2016 Jan;12(1):33-40. doi: 10.1016/j.soard.2015.04.018. Epub 2015 Apr 30.
Most population-based studies lack long-term data, making the reporting of true mortality and outcome rates difficult. An accurate estimate of these rates in a high-risk population is critical for obtaining informed consent, especially for an elective procedure such as Roux-en-Y gastric bypass (RYGB).
To examine the longitudinal outcomes of RYGB.
The California Office of Statewide Health Planning and Development (OSHPD) longitudinal database.
The OSHPD longitudinal database was queried for patients who underwent RYGB between 1995 and 2009. The primary outcome was mortality rates at 1, 5, and 10 years. Secondary outcomes were marginal ulcer and reoperation. The Cox hazard proportional analysis was used to determine adjusted survival and long-term outcomes for laparoscopic RYGB compared with open RYGB.
The study included 129,432 RYGB patients. Rates of laparoscopy increased from 3% to 35% from 1995 to 2004 and then steeply increased to 80% in 2005 and to 93% in 2009. Overall mortality rate at 1, 5, and 10 years was 2.2%, 4.4%, and 8.1%, respectively; the rates of marginal ulcer were .3%, .7%, and 1%, respectively; and the reoperation rates were .3%, .8%, and 1.2%, respectively. Predictors of poor outcomes were male gender, age, smoking, alcohol, Medicare, Medi-Cal insurance, and Asian or Native American race. The laparoscopic approach was protective against death (hazard ratio [HR] 95% confidence interval [95%CI]: .63[.58-.69]) and long-term complications (HR .78[.72-.85]).
This longitudinal population study showed high rates of mortality following RYGB, with improved long-term outcomes when the laparoscopic approach was used.
大多数基于人群的研究缺乏长期数据，这使得真实死亡率和结局率的报告变得困难。准确估计高危人群中的这些比率对于获得知情同意至关重要，尤其是对于像Roux-en-Y胃旁路术（RYGB）这样的择期手术。
研究RYGB的纵向结局。
加利福尼亚州全州卫生规划与发展办公室（OSHPD）纵向数据库。
查询OSHPD纵向数据库中1995年至2009年间接受RYGB的患者。主要结局是1年、5年和10年的死亡率。次要结局是边缘溃疡和再次手术。采用Cox风险比例分析来确定腹腔镜RYGB与开放RYGB相比的调整后生存率和长期结局。
该研究纳入了129,432例RYGB患者。从1995年到2004年，腹腔镜手术率从3%增加到35%，然后在2005年急剧增加到80%，2009年增加到93%。1年、5年和10年的总体死亡率分别为2.2%、4.4%和8.1%；边缘溃疡率分别为0.3%、0.7%和1%；再次手术率分别为0.3%、0.8%和1.2%。不良结局的预测因素包括男性、年龄、吸烟、饮酒、医疗保险、医疗救助保险以及亚洲或美洲原住民种族。腹腔镜手术方法可降低死亡风险（风险比[HR] 95%置信区间[95%CI]：0.63[0.58 - 0.69]）和长期并发症风险（HR 0.78[0.72 - 0.85]）。
这项纵向人群研究显示RYGB术后死亡率较高，采用腹腔镜手术方法可改善长期结局。
