Morgan David J R, Ho Kwok M
*Department of Intensive Care Medicine, St John of God Hospital Subiaco, Subiaco, Western Australia, Australia †School of Population Health, University of Western Australia, Nedlands, Western Australia, Australia ‡School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.
Ann Surg. 2017 Feb;265(2):244-252. doi: 10.1097/SLA.0000000000001891.
Assess the incidence and determinants of hospitalization for deliberate self-harm and mental health disorders, and suicide after bariatric surgery.
Limited recent literature suggests an increase in deliberate self-harm following bariatric surgery.
A state-wide, population-based, self-matched, longitudinal cohort study over a 5-year period between 2007 and 2011. Utilizing the Western Australian Department of Health Data Linkage Unit records, all patients undergoing bariatric surgery (n = 12062) in Western Australia were followed for an average 30.4 months preoperatively and 40.6 months postoperatively.
There were 110 patients (0.9%) hospitalized for deliberate self-harm, which was higher than the general population [incidence rate ratio (IRR) 1.47, 95% confidence interval (CI) 1.11-1.94, P = 0.005]. Compared with before surgery, there was no significant increase in deliberate self-harm hospitalizations (IRR 0.79, 95% CI 0.54-1.16; P = 0.206) and a reduction in overall mental illness related hospitalizations (IRR 0.76, 95% CI 0.63-0.91; P = 0.002) after surgery. Younger age, no private-health insurance cover, a history of hospitalizations due to depression before surgery, and gastrointestinal complications after surgery were predictors for deliberate self-harm hospitalizations after bariatric surgery. Three suicides occurred during the follow-up period, a rate comparable to the general population during the same time period (IRR 0.61, 95% CI 0.11-2.27, P = 0.444).
Hospitalization for deliberate self-harm in bariatric patients was more common than the general population, but an increased incidence of deliberate self-harm after bariatric surgery was not observed. Hospitalization for depression before surgery and major postoperative gastrointestinal complications after bariatric surgery are potentially modifiable risk factors for deliberate self-harm after bariatric surgery.
评估减肥手术后蓄意自伤、精神健康障碍住院治疗及自杀的发生率和决定因素。
近期有限的文献表明减肥手术后蓄意自伤有所增加。
一项基于全州人口的自我匹配纵向队列研究，研究时间为2007年至2011年的5年期间。利用西澳大利亚州卫生部数据链接部门的记录，对西澳大利亚州所有接受减肥手术的患者（n = 12062）进行术前平均30.4个月和术后平均40.6个月的随访。
110名患者（0.9%）因蓄意自伤住院，高于普通人群[发病率比（IRR）1.47，95%置信区间（CI）1.11 - 1.94，P = 0.005]。与手术前相比，减肥手术后蓄意自伤住院率无显著增加（IRR 0.79，95% CI 0.54 - 1.16；P = 0.206），且总体精神疾病相关住院率有所降低（IRR 0.76，95% CI 0.63 - 0.91；P = 0.002）。年龄较小、没有私人医疗保险、术前有因抑郁住院史以及术后出现胃肠道并发症是减肥手术后蓄意自伤住院的预测因素。随访期间发生了3起自杀事件，发生率与同期普通人群相当（IRR 0.61，95% CI 0.11 - 2.27，P = 0.444）。
减肥患者因蓄意自伤住院比普通人群更常见，但未观察到减肥手术后蓄意自伤发生率增加。术前因抑郁住院以及减肥手术后出现严重的术后胃肠道并发症是减肥手术后蓄意自伤潜在的可改变风险因素。
