腹腔镜Roux-en-Y胃旁路术后术前体重减轻相关的结局
Outcomes associated with preoperative weight loss after laparoscopic Roux-en-Y gastric bypass.
作者信息
Blackledge Camille, Graham Laura A, Gullick Allison A, Richman Joshua, Stahl Richard, Grams Jayleen
机构信息
Department of Surgery, University of Alabama at Birmingham, 1720 2nd Ave South, KB 401, Birmingham, AL, 35294, USA.
Department of Surgery, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
出版信息
Surg Endosc. 2016 Nov;30(11):5077-5083. doi: 10.1007/s00464-016-4856-3. Epub 2016 Mar 11.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for achieving and maintaining weight loss and for improving obesity-related comorbidities. As part of the approval process for bariatric surgery, many insurance companies require patients to have documented recent participation in a supervised weight loss program. The goal of this study was to evaluate the relationship of preoperative weight changes with outcomes following LRYGB.
METHODS
A retrospective review was conducted of adult patients undergoing LRYGB between 2008 and 2012 at a single institution. Patients were stratified into quartiles based on % excess weight gain (0-4.99 % and ≥5 % EWG) and % excess weight loss (0-4.99 % and ≥5 % EWL). Generalized linear models were used to examine differences in postoperative weight outcomes at 6, 12, and 24 months. Covariates included in the final adjusted models were determined using backwards stepwise selection.
RESULTS
Of the 300 patients included in the study, there were no significant demographic differences among the quartiles. However, there was an increased time to operation for patients who gained or lost ≥5 % excess body weight (p < 0.001). Although there was no statistical significance in postoperative complications, there was a higher rate of complications in patients with ≥5 % EWG compared to those with ≥5 % EWL (12.5 vs. 4.8 %, respectively; p = 0.29). Unadjusted and adjusted generalized linear models showed no statistically significant association between preoperative % excess weight change and weight loss outcomes at 24 months.
CONCLUSION
Patients with the greatest % preoperative excess weight change had the longest intervals from initial visit to operation. No significant differences were seen in perioperative and postoperative outcomes. This study suggests preoperative weight loss requirements may delay the time to operation without improving postoperative outcomes or weight loss.
背景
腹腔镜Roux-en-Y胃旁路术（LRYGB）是实现并维持体重减轻以及改善肥胖相关合并症的有效治疗方法。作为减肥手术审批流程的一部分，许多保险公司要求患者有近期参与受监督减肥计划的记录。本研究的目的是评估LRYGB术后术前体重变化与结局之间的关系。
方法
对2008年至2012年在单一机构接受LRYGB的成年患者进行回顾性研究。根据超重百分比增加（0-4.99%和≥5% EWG）和超重减轻百分比（0-4.99%和≥5% EWL）将患者分为四分位数。使用广义线性模型检查术后6、12和24个月体重结局的差异。最终调整模型中纳入的协变量通过向后逐步选择确定。
结果
研究纳入的300例患者中，四分位数之间在人口统计学上无显著差异。然而，超重或减重≥5%的患者手术时间延长（p<0.001）。虽然术后并发症无统计学意义，但超重≥5%的患者并发症发生率高于减重≥5%的患者（分别为12.5%和4.8%；p=0.29）。未调整和调整后的广义线性模型显示，术前超重百分比变化与24个月时的体重减轻结局之间无统计学显著关联。
结论
术前超重百分比变化最大的患者从初次就诊到手术的间隔时间最长。围手术期和术后结局未见显著差异。本研究表明，术前减肥要求可能会延迟手术时间，而不会改善术后结局或体重减轻情况。
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