Lagerros Ylva Trolle, Brandt Lena, Hedberg Jakob, Sundbom Magnus, Bodén Robert
*Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden †Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden ‡Department of Surgical Sciences, Uppsala University, Uppsala, Sweden §Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
Ann Surg. 2017 Feb;265(2):235-243. doi: 10.1097/SLA.0000000000001884.
The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP).
Concerns regarding severe adverse psychiatric outcomes after GBP have been raised.
This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery.
A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12).
The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
本研究旨在探讨胃旁路手术（GBP）后自我伤害、因抑郁症住院及自杀死亡的风险。
人们已对GBP术后严重的不良精神后果表示担忧。
这项全国性的纵向自我匹配队列研究纳入了2008年至2012年期间接受GBP手术的22539例患者。通过瑞典国家患者登记册、处方药登记册和死亡原因登记册对他们进行识别。随访时间长达2年。主要结局指标为术前有自我伤害和/或抑郁症的患者与无此暴露的患者相比，术后自我伤害或因抑郁症住院的风险比（HRs）；以及术后自杀的标准化死亡比（SMR）。
与术前无自我伤害诊断的GBP患者相比，术前2年内有自我伤害诊断的患者在随访2年内自我伤害的HR为36.6（95%置信区间[CI]25.5 - 52.4）。与术前无抑郁症诊断的GBP患者相比，GBP手术前有抑郁症诊断的患者术后因抑郁症住院的HR为52.3（95%CI 30.6 - 89.2）。GBP术后女性自杀的SMR升高（n = 13），为4.50（95%CI 2.50 - 7.50）。男性自杀的SMR（n = 4）为1.71（95%CI 0.54 - 4.12）。
术后自我伤害和因抑郁症住院风险增加主要归因于术前有自我伤害或抑郁症诊断的患者。需要提高认识以识别有自我伤害或抑郁症病史的脆弱患者，这些患者在GBP术后可能需要精神科支持。
