Gribsholt Sigrid Bjerge, Thomsen Reimar Wernich, Svensson Elisabeth, Richelsen Bjørn
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Surg Obes Relat Dis. 2017 Apr;13(4):581-587. doi: 10.1016/j.soard.2016.10.007. Epub 2016 Oct 17.
Few population-based studies provide data on mortality after bariatric surgery. We hypothesized that hypoglycemia could be an underdiagnosed cause of death.
To examine perioperative, all-cause, and cause-specific long-term mortality in Roux-en-Y gastric bypass (RYGB) patients versus population comparisons.
Danish nationwide population-based cohort study.
We included all 9895 patients who underwent RYGB during 2006-2010, and a 1:25 age- and gender-matched comparison cohort (n = 247,366) (0.3% lost to follow up). We compared mortality rates and computed mortality rate ratios (MRR) for all-cause and cause-specific mortality using Cox regression analysis. For deceased RYGB patients (n = 91), we conducted a detailed medical record audit.
The perioperative (30-days) mortality after RYGB was .04% (4/9895). After 4.2 years, RYGB-related mortality (deaths due to intestinal obstruction/intra-abdominal leakage) was .15% (16/9895). All-cause mortality was very similar in the 2 cohorts (median age, 40.2 years; 21.7% men): RYGB cohort, .89% (n = 91); comparison cohort, .92% (n = 2204); MRR = 1.03 (95% confidence interval [CI], .84-1.27). Mortality due to suicide (2.78; 95% CI, 1.44-5.33), accidents (2.29; 95% CI, 1.16-4.54), gastrointestinal diseases (2.01; 95% CI, 1.06-3.84), and infectious diseases (1.75; 95% CI, .98-3.17) was higher in the RYGB cohort versus comparison groups, but mortality from cancer was lower (0.43; 95% CI, .27-.70). Our medical record audit indicated that 8% of deaths after RYGB (n = 7) were possibly hypoglycemia related.
Perioperative mortality after RYGB is low in Denmark, and subsequent all-cause mortality is similar to that of matched comparisons. After RYGB, patients have substantially increased mortality due to external causes such as suicide, accidents, and possibly hypoglycemia.
很少有基于人群的研究提供有关减肥手术后死亡率的数据。我们推测低血糖可能是一种未被充分诊断的死亡原因。
比较Roux-en-Y胃旁路术（RYGB）患者与总体人群的围手术期、全因及特定原因的长期死亡率。
丹麦全国性基于人群的队列研究。
我们纳入了2006年至2010年间接受RYGB手术的所有9895例患者，以及一个年龄和性别匹配的1:25对照队列（n = 247,366）（0.3%失访）。我们使用Cox回归分析比较死亡率，并计算全因及特定原因死亡率的死亡率比（MRR）。对于已故的RYGB患者（n = 91），我们进行了详细的病历审核。
RYGB术后围手术期（30天）死亡率为0.04%（4/9895）。4.2年后，RYGB相关死亡率（因肠梗阻/腹腔内渗漏导致的死亡）为0.15%（16/9895）。两个队列的全因死亡率非常相似（中位年龄40.2岁；男性占21.7%）：RYGB队列，0.89%（n = 91）；对照队列，0.92%（n = 2204）；MRR = 1.03（95%置信区间[CI]，0.84 - 1.27）。与对照组相比，RYGB队列中因自杀（2.78；95% CI，1.44 - 5.33）、意外事故（2.29；95% CI，1.16 - 4.54）、胃肠道疾病（2.01；95% CI，1.06 - 3.84）和传染病（1.75；95% CI，0.98 - 3.17）导致的死亡率更高，但癌症死亡率更低（0.43；95% CI，0.27 - 0.70）。我们的病历审核表明，RYGB术后8%的死亡（n = 7）可能与低血糖有关。
在丹麦，RYGB术后围手术期死亡率较低，随后的全因死亡率与匹配对照组相似。RYGB术后，患者因自杀、意外事故以及可能的低血糖等外部原因导致的死亡率大幅增加。
