Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Avenue, Building 16, Rm 140-E, Ann Arbor, MI, 48109-2800, USA.
Surg Endosc. 2018 Mar;32(3):1382-1388. doi: 10.1007/s00464-017-5819-z. Epub 2017 Aug 24.
Bariatric surgery is a safe and effective treatment for clinically severe obesity, but inequity in male and female utilization is well recognized. Approximately 20% of patients undergoing bariatric surgery are male. This paper aims to describe differences in outcomes by gender and to understand the physiologic and psychological differences that may explain this gender gap.
We examined 61,708 patients from the Michigan Bariatric Surgery Collaborative (MBSC) undergoing primary bariatric surgery between 2006 and 2016. Clinical data regarding demographics, comorbidities, and outcomes were compared by gender. Preoperative and 1-year postoperative surveys gathered psychological outcomes.
This cohort was consistent with the national population with approximately 22% male patients. There were several significant differences between males and females at the time of surgery. Males tended to be older, have a higher BMI, be married, have lower self-reported depression scores, and have more comorbidities (all p < 0.05). Postoperatively, males suffered more serious complications than women (2.67 vs. 2.12, respectively, p < 0.05). At 1 year postoperatively, males were significantly more satisfied with their operation despite increased complications, decreased weight loss, and decreased rates of comorbidity resolution as compared to females (all p < 0.05).
Despite significantly lower weight loss and increased complication rates, males tend to have markedly higher satisfaction and psychological well-being scores than females. To improve outcomes in males, earlier referral to surgery may help to significantly reduce their risk. Conversely, increased attention to psychological support in the perioperative period for females may lead to improved psychological outcomes (i.e., body image, depression, psychological well-being).
减重手术是治疗临床重度肥胖症的一种安全有效的方法，但男性和女性的利用不平等是众所周知的。大约 20%接受减重手术的患者为男性。本文旨在描述性别差异的结果，并了解可能解释这种性别差距的生理和心理差异。
我们检查了密歇根州减重手术协作组（MBSC）在 2006 年至 2016 年间进行的 61708 例原发性减重手术患者。按性别比较了与人口统计学、合并症和结果相关的临床数据。术前和术后 1 年的调查收集了心理结果。
该队列与全国人口情况一致，男性患者约占 22%。在手术时，男性和女性之间存在几个显著差异。男性往往年龄较大、BMI 较高、已婚、自我报告的抑郁评分较低，并且合并症更多（均 P<0.05）。术后，男性比女性遭受更严重的并发症（分别为 2.67%和 2.12%，P<0.05）。术后 1 年，尽管并发症增加、体重减轻减少、合并症缓解率降低，但男性对手术的满意度明显高于女性（均 P<0.05）。
尽管体重减轻明显减少且并发症发生率增加，但男性的满意度和心理健康评分往往明显高于女性。为了改善男性的结果，早期转诊手术可能有助于显著降低他们的风险。相反，在围手术期增加对女性的心理支持可能会导致改善心理结果（即身体形象、抑郁、心理健康）。
