Al-Khyatt Waleed, Ryall Rebecca, Leeder Paul, Ahmed Javed, Awad Sherif
The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK.
Cleveland Clinic, Digestive Diseases Institute, Abu Dhabi, United Arab Emirates.
Obes Surg. 2017 Jun;27(6):1446-1452. doi: 10.1007/s11695-016-2500-x.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for morbid obesity resulting in approx. 70% excess weight loss (EWL) at 1-2 years. The aim of this study was to identify factors predictive of inadequate EWL following primary LRYGB.
Data on consecutive patients who underwent primary LRYGB between September 2009 and March 2013 were collected prospectively. The effects of age, gender, baseline body mass index (BMI), preoperative EWL, length of time between initial consultation and surgery (TtS), presence of diabetes mellitus (DM), arthritis, obstructive sleep apnea (OSA) and postoperative length of hospital stay (LOS) on EWL at 12 months were studied. General linear regression models were used to evaluate group differences in EWL and to assess independent associations between baseline variables and EWL at 12 months. Stepwise regression analyses were used to estimate individual contributions of independent variables to the variance in EWL at 12 months. In this study, inadequate EWL was defined as <50% EWL at 12 months.
LRYGB was performed in 227 patients with a mean ± SD age and BMI of 48.6 ± 11 years and 53.6 ± 7.1 kg/m, respectively. Female to male ratio was 3:1. EWL at 12 months had an inverse correlation with age (p = 0.01), baseline BMI (p < 0.001), TtS (p = 0.001), OSA (p = 0.039) and DM (p = 0.039). Conversely, there was a significant positive association between preoperative EWL and that at 12 months (p = 0.009). There was no effect of gender, arthritis or LOS on EWL at 12 months. Multiple regression analysis demonstrated inadequate EWL at 12 months to be predicted by older age (>60 years), patients with diabetes, higher baseline BMI (>60), those who gained weight preoperatively and in patients who waited longer than 18 months for surgery (p = 0.027).
Preoperative factors that predict inadequate EWL at 12 months following primary LRYGB include higher initial BMI, older age, presence of DM and preoperative weight gain. Identification of these factors preoperatively should aid in providing intensive support to these at-risk patient groups.
腹腔镜Roux-en-Y胃旁路术（LRYGB）是治疗病态肥胖的一种有效方法，术后1 - 2年可使约70%的患者实现超重减轻（EWL）。本研究旨在确定初次LRYGB术后EWL不足的预测因素。
前瞻性收集2009年9月至2013年3月期间接受初次LRYGB手术的连续患者的数据。研究年龄、性别、基线体重指数（BMI）、术前EWL、初次咨询与手术之间的时间间隔（TtS）、糖尿病（DM）、关节炎、阻塞性睡眠呼吸暂停（OSA）以及术后住院时间（LOS）对12个月时EWL的影响。使用一般线性回归模型评估EWL的组间差异，并评估基线变量与12个月时EWL之间的独立关联。采用逐步回归分析估计自变量对12个月时EWL方差的个体贡献。在本研究中，EWL不足定义为12个月时EWL < 50%。
227例患者接受了LRYGB手术，平均年龄±标准差为48.6 ± 11岁，BMI为53.6 ± 7.1 kg/m²。男女比例为3:1。12个月时的EWL与年龄（p = 0.01）、基线BMI（p < 0.001）、TtS（p = 0.001）、OSA（p = 0.039）和DM（p = 0.039）呈负相关。相反，术前EWL与12个月时的EWL之间存在显著正相关（p = 0.009）。性别、关节炎或LOS对12个月时的EWL没有影响。多元回归分析表明，12个月时EWL不足可由年龄较大（> 60岁）、患有糖尿病的患者、较高的基线BMI（> 60）、术前体重增加的患者以及等待手术超过18个月的患者预测（p = 0.027）。
初次LRYGB术后12个月时EWL不足的术前预测因素包括较高的初始BMI、年龄较大、存在DM和术前体重增加。术前识别这些因素应有助于为这些高危患者群体提供强化支持。
