Department of Surgery, University of Colorado, Denver, Aurora, Colorado; Children's Hospital of Colorado, Aurora, Colorado.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Surg Obes Relat Dis. 2018 Sep;14(9):1374-1386. doi: 10.1016/j.soard.2018.04.002. Epub 2018 Apr 17.
Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up.
We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents.
Data were obtained from clinical research networks using a common data model to extract data from each site.
Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period.
This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (±standard deviation) age of 17.3 (±1.6) years and mean BMI of 49.8 (± 7.8) kg/m. Procedures included Roux-en-Y gastric bypass (RYGB; n = 177), sleeve gastrectomy (SG; n = 306), and laparoscopic adjustable gastric banding (n = 61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of -31% (-30% to -33%), -28% (-27% to -29%), and -10% (-8% to -12%), were estimated at 1 year. For RYGB and SG, BMI changes of -29% (-26% to -33%) and -25% (-22% to -28%) were estimated at 3 years.
Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1- and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction.
减重手术已被用于治疗青少年重度肥胖，但大多数研究规模较小且随访时间有限。
我们假设电子健康记录数据可用于比较青少年减重手术的效果。
使用通用数据模型从临床研究网络中获取数据，从每个站点提取数据。
确定了 2005 年至 2015 年间接受初次减重手术的青少年。对所有手术患者使用随机效应线性回归估计 1、3 和 5 年时体重指数（BMI）的百分比变化。对每个时间点>25 例患者的手术进行倾向评分调整估计和 95%置信区间。
该队列包括 544 名青少年，主要为女性（79%）和白人（66%），平均（±标准差）年龄为 17.3（±1.6）岁，平均 BMI 为 49.8（±7.8）kg/m2。手术包括 Roux-en-Y 胃旁路术（RYGB；n=177）、袖状胃切除术（SG；n=306）和腹腔镜可调节胃束带术（n=61）。对于接受 RYGB、SG 和腹腔镜可调节胃束带术的患者，1 年时 BMI 变化的估计值分别为-31%（-30%至-33%）、-28%（-27%至-29%）和-10%（-8%至-12%）。对于 RYGB 和 SG，3 年时 BMI 变化的估计值分别为-29%（-26%至-33%）和-25%（-22%至-28%）。
SG 和 RYGB 术后青少年在 1 年和 3 年随访时 BMI 下降幅度更大，而腹腔镜可调节胃束带术对 BMI 的降低效果显著较低。
