Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada4Department of Surgery, Sunnyb.
JAMA Surg. 2016 Mar;151(3):226-32. doi: 10.1001/jamasurg.2015.3414.
Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.
To compare the risk of self-harm behaviors before and after bariatric surgery.
DESIGN, SETTING, AND PARTICIPANTS: In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.
Self-harm emergencies 3 years before and after surgery.
The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P = .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.
In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.
在接受减重手术的患者中，常有自伤行为，包括自杀意念和过去的自杀企图。然而，目前尚不清楚这些行为是通过手术减轻还是加重。
比较减重手术前后自伤行为的风险。
设计、环境和参与者：在这项基于人群的、自我匹配的、纵向队列分析中，我们研究了 8815 名来自加拿大安大略省的成年人，他们在 2006 年 4 月 1 日至 2011 年 3 月 31 日期间接受了减重手术。每位患者的随访时间为手术前 3 年和手术后 3 年。
手术前 3 年和手术后 3 年的自伤急诊情况。
该队列包括 8815 名患者，其中 7176 名（81.4%）为女性，7063 名（80.1%）年龄在 35 岁或以上，8681 名（98.5%）接受了胃旁路手术。在随访期间，共有 111 名患者发生了 158 次自伤急诊。总体而言，与手术前相比（每 1000 患者年 2.33 次），手术后自伤急诊显著增加（每 1000 患者年 3.63 次），相当于率比（RR）为 1.54（95%CI，1.03-2.30；P=0.007）。在年龄大于 35 岁（RR，1.76；95%CI，1.05-2.94；P=0.03）、低收入人群（RR，2.09；95%CI，1.20-3.65；P=0.01）和居住在农村地区的患者中（RR，6.49；95%CI，1.42-29.63；P=0.02），手术后自伤急诊发生率高于手术前。最常见的自伤机制是故意过量用药（115[72.8%]）。共有 147 例（93.0%）事件发生在手术前 5 年内被诊断患有精神疾病的患者中。
在这项研究中，减重手术后自伤急诊的风险增加，这凸显了在随访期间筛查自杀风险的必要性。
