Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States.
Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States.
Int J Surg. 2018 Jun;54(Pt A):163-169. doi: 10.1016/j.ijsu.2018.04.025. Epub 2018 Apr 22.
Prior studies have established that race and socioeconomic factors may influence weight loss after bariatric surgery. Few studies have focused on laparoscopic sleeve gastrectomy (LSG). The objective of this study is to determine if demographic factors may predict postoperative weight loss following LSG.
Prospectively collected data on 713 consecutive primary LSG operations performed with the same technique between February 2010 and May 2016 by a single surgeon (PG) were analyzed. Multiple regression analysis was done to determine if gender, race, or socioeconomic factors such as insurance and employment status correlated with postoperative weight loss. The presence of chronic comorbidities affecting quality of life such as Type II Diabetes and Obstructive Sleep Apnea (OSA) were also recorded and analyzed.
All studied groups had similar preoperative body mass index (BMI) (mean 46 kg/m). Race was not significantly associated with weight loss at any postoperative interval. Male gender was associated with increased weight loss through the first three months (48.2 ± 12.5 lbs vs. 40.5 ± 11 lbs; p = 0.0001). Patients with diabetes had significantly less weight loss at the 6 through 18 month intervals (50.4 ± 17.9 lbs vs. 59.6 ± 15.6 lbs at six months; p = 0.00032; 53.3 ± 25.4lbs vs. 80.5 ± 31.3lbs at 18 months; p = 0.008). Patients with obstructive sleep apnea had significantly less weight loss at the two-year interval (57.5 ± 29.2 lbs) vs. those without obstructive sleep apnea (69.6 ± 23.5 lbs; p = 0.047). Those with Medicare compared to Medicaid or commercial insurance had decreased weight loss through the first year (52.8 ± 20.8 lbs vs. 71.4 ± 26.4 lbs vs. 68.6 ± 24.7 lbs; p = 0.0496). Notably, a higher percentage of patients in the Medicare insurance group were also diabetic and had OSA (65% vs. 34% vs. 36%; p = 0.002; 80% vs. 55% vs. 57%; p = 0.01). Finally, those patients who were students had the greatest weight loss at two years postoperatively with the least weight loss seen in retired patients followed by those on disability (108.0 ± 21.5 lbs vs. 26.0 lbs vs. 46.0 ± 19.7 lbs; p = 0.04).
Several demographic factors including comorbidities, insurance status, and employment may significantly affect weight loss patterns following LSG. Further studies are needed to evaluate whether demographic differences impact long term weight loss. Differences in outcomes based on patient demographics may be beneficial in the planning of the allocation of healthcare resources.
先前的研究已经证实，种族和社会经济因素可能会影响减重手术后的减肥效果。很少有研究关注腹腔镜袖状胃切除术（LSG）。本研究的目的是确定人口统计学因素是否可以预测 LSG 后的术后体重减轻。
对 2010 年 2 月至 2016 年 5 月间由同一位外科医生（PG）进行的 713 例连续原发性 LSG 手术的前瞻性收集数据进行了分析。采用多元回归分析确定性别、种族以及保险和就业状况等社会经济因素是否与术后体重减轻相关。还记录并分析了影响生活质量的慢性合并症的存在情况，如 II 型糖尿病和阻塞性睡眠呼吸暂停（OSA）。
所有研究组的术前体重指数（BMI）（平均 46kg/m）相似。种族与任何术后间隔的体重减轻均无显著相关性。男性在术后前三个月的体重减轻更为明显（48.2±12.5 磅比 40.5±11 磅；p=0.0001）。患有糖尿病的患者在 6 至 18 个月的间隔内体重减轻明显较少（50.4±17.9 磅比 59.6±15.6 磅，六个月时；p=0.00032；53.3±25.4 磅比 80.5±31.3 磅，18 个月时；p=0.008）。患有阻塞性睡眠呼吸暂停的患者在两年间隔时体重减轻明显较少（57.5±29.2 磅），而没有阻塞性睡眠呼吸暂停的患者则体重减轻较多（69.6±23.5 磅；p=0.047）。与医疗保险或商业保险相比，医疗保险患者在第一年的体重减轻较少（52.8±20.8 磅比 71.4±26.4 磅比 68.6±24.7 磅；p=0.0496）。值得注意的是，医疗保险组中更多的患者患有糖尿病和 OSA（65%比 34%比 36%；p=0.002；80%比 55%比 57%；p=0.01）。最后，那些学生患者在术后两年内体重减轻最多，而退休患者和残疾患者的体重减轻最少（108.0±21.5 磅比 26.0 磅比 46.0±19.7 磅；p=0.04）。
包括合并症、保险状况和就业状况在内的几种人口统计学因素可能会显著影响 LSG 后的减肥模式。需要进一步的研究来评估人口统计学差异是否会影响长期减肥效果。基于患者人口统计学的结果差异可能有助于医疗资源的规划分配。
