King Wendy C, Chen Jia-Yuh, Belle Steven H, Courcoulas Anita P, Dakin Gregory F, Elder Katherine A, Flum David R, Hinojosa Marcelo W, Mitchell James E, Pories Walter J, Wolfe Bruce M, Yanovski Susan Z
University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
JAMA. 2016 Apr 5;315(13):1362-71. doi: 10.1001/jama.2016.3010.
The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described.
To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement.
DESIGN, SETTING, AND PARTICIPANTS: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported.
Bariatric surgery as clinical care.
Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]).
Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3.
Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3.
clinicaltrials.gov Identifier: NCT00465829.
Roux-en-Y胃旁路术（RYGB）或腹腔镜可调节胃束带术（LAGB）后疼痛和身体功能改善的可变性及持久性尚未得到充分描述。
报告减肥手术后前3年疼痛和身体功能的变化，并确定与改善相关的因素。
设计、地点和参与者：减肥手术纵向评估-2是一项在美国10家医院进行的观察性队列研究。2005年2月至2009年2月招募了接受减肥手术的重度肥胖成年人。在手术前及此后每年进行研究评估。报告了截至2012年10月的3年随访情况。
作为临床治疗的减肥手术。
主要结局是使用医学结局研究36项简短健康调查（SF-36）评分，从术前到术后疼痛和功能的临床意义上的改善（即基于常模的评分提高≥5分[范围0 - 100]），以及使用既定阈值的400米步行时间（即改善≥24秒）。次要结局是使用西安大略和麦克马斯特大学骨关节炎指数的临床意义上的改善（即转化评分提高≥9.7个疼痛点和≥9.3个功能点[范围0 - 100]）。
2458名参与者中，2221名完成了基线和随访评估（1743名[78.5%]为女性；中位年龄为47岁；中位体重指数[BMI]为45.9；70.4%接受RYGB；25.0%接受LAGB）。在第1年，57.6%（95%CI，55.3% - 59.9%）的参与者身体疼痛有临床意义上的改善，76.5%（95%CI，74.6% - 78.5%）的参与者身体功能有改善，59.5%（95%CI，56.4% - 62.7%）的参与者步行时间有改善。此外，在基线时有严重膝关节或残疾（633名）、或髋关节疼痛或残疾（500名）的参与者中，约四分之三在膝关节疼痛（77.1%[95%CI，73.5% - 80.7%]）和髋关节功能（79.2%[95%CI，75.3% - 83.1%]）方面有特定关节的改善。在第1年到第3年之间，身体疼痛的改善率显著降至48.6%（95%CI，46.0% - 51.1%），身体功能的改善率降至70.2%（95%CI，67.8% - 72.5%），但步行时间、膝关节和髋关节疼痛以及膝关节和髋关节功能的改善率没有下降（所有P≥0.05）。年龄较小、男性、收入较高、BMI较低以及术前抑郁症状较少；术后无糖尿病且无静脉水肿伴溃疡（无病史或已缓解）；以及术前到术后体重和抑郁症状的减轻与第1、2和3年多个结局从术前到术后的改善相关。
在接受减肥手术的重度肥胖参与者队列中，与基线相比很大比例的人在3年中疼痛、身体功能和步行时间有改善，但疼痛和身体功能改善的比例在第1年到第3年之间有所下降。
clinicaltrials.gov标识符：NCT00465829。
