Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California.
Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, Unaizah College of Medicine, Qassim University, Saudi Arabia.
Surg Obes Relat Dis. 2018 Jul;14(7):943-950. doi: 10.1016/j.soard.2018.03.024. Epub 2018 Mar 26.
As the vertical sleeve gastrectomy (VSG) becomes increasingly popular, its effect on postoperative micronutrient levels, such as thiamine, becomes more important. We previously found a 1.8% prevalence of thiamine deficiency in bariatric patients before surgery.
The aims of this study were to determine the prevalence of thiamine deficiency at our center after VSG and to explore possible predictors of postoperative thiamine levels.
University hospital, United States.
A retrospective chart review was performed on 147 bariatric patients between 18- and 65-years old who underwent VSG between April 2011 and February 2015. Demographic characteristics, preoperative body mass index (BMI), obesity-associated co-morbidities, alcohol intake, smoking habits, insurance type, calendar year of the procedure, occurrence of postoperative complications, and compliance with postoperative nutrition and follow-up appointment guidelines were extracted from clinical charts. We defined thiamine deficiency as<78 nM on any lab draw within 1 year after the VSG. The χ, Fisher exact, and Mann-Whitney U tests, and multivariate logistic regression models were created to analyze the association of the above factors with thiamine deficiency after a VSG.
Of 147 patients, 105 met inclusion criteria and were analyzed, of whom 27 (25.7%) had thiamine deficiency. Overall median age was 42 years (interquartile ratio: 36, 49). The majority of patients were either African Americans or Caucasian (47.6% and 44.8%, respectively), female (77.1%), and compliant with vitamins (81.0%). The overall mean preoperative BMI was 46.4 kg/m. Patients with thiamine deficiency were more likely to be African American (66.7%, P = .024), have a larger preoperative BMI (P = .026), and to report repetitive episodes of nausea (59.3%, P = .002) and vomiting (44.4%, P = .001) at any of their postoperative appointments within 1 year after surgery. Compliance with vitamins did not differ between those with or without thiamine deficiency (70.4%, 84.6%, P = .10). After controlling for all factors, African American race (odds ratio [OR] 3.9, P = .019), higher preoperative BMI (OR 1.13, P = .001), nausea (OR 3.81, P = .02), and vomiting (OR 3.49, P = .032) were independent risk factors for the development of thiamine deficiency.
We found an alarmingly high prevalence of thiamine deficiency in postoperative SG patients. This disorder may have serious consequences including Wernicke encephalopathy; hence, it is important to identify predictive demographic, postoperative, and behavioral factors so that appropriate measures can be taken to prevent thiamine deficiency in VSG patients.
随着垂直袖状胃切除术（VSG）的日益普及，其对术后微量营养素水平（如硫胺素）的影响变得更为重要。我们之前发现，在接受减重手术的患者中，术前有 1.8%存在硫胺素缺乏症。
本研究旨在确定我们中心在 VSG 术后硫胺素缺乏症的患病率，并探讨术后硫胺素水平的可能预测因素。
美国大学医院。
对 2011 年 4 月至 2015 年 2 月间接受 VSG 的 147 名年龄在 18 至 65 岁之间的肥胖症患者进行回顾性病历分析。从临床病历中提取人口统计学特征、术前体重指数（BMI）、肥胖相关合并症、饮酒量、吸烟习惯、保险类型、手术年份、术后并发症的发生情况以及术后营养和随访预约指南的依从性。我们将任何一次术后 1 年内的硫胺素<78 nM 定义为硫胺素缺乏症。采用卡方检验、Fisher 确切概率法和 Mann-Whitney U 检验以及多变量逻辑回归模型分析上述因素与 VSG 后硫胺素缺乏症的关系。
在 147 名患者中，有 105 名符合纳入标准并进行了分析，其中 27 名（25.7%）存在硫胺素缺乏症。患者的总体中位年龄为 42 岁（四分位间距：36、49）。大多数患者为非裔美国人或白种人（分别为 47.6%和 44.8%），女性（77.1%），并遵守维生素补充规定（81.0%）。患者的总体平均术前 BMI 为 46.4kg/m2。存在硫胺素缺乏症的患者更有可能是非裔美国人（66.7%，P=0.024），术前 BMI 更大（P=0.026），且在术后 1 年内的任何一次随访中，报告反复出现恶心（59.3%，P=0.002）和呕吐（44.4%，P=0.001）。在补充维生素方面，有硫胺素缺乏症的患者与无硫胺素缺乏症的患者之间没有差异（70.4%、84.6%，P=0.10）。在控制所有因素后，非裔美国人种族（比值比[OR]3.9，P=0.019）、较高的术前 BMI（OR 1.13，P=0.001）、恶心（OR 3.81，P=0.02）和呕吐（OR 3.49，P=0.032）是发生硫胺素缺乏症的独立危险因素。
我们发现 VSG 术后患者的硫胺素缺乏症患病率高得惊人。这种疾病可能会导致严重的后果，包括韦尼克脑病；因此，确定预测性的人口统计学、术后和行为因素很重要，以便采取适当措施预防 VSG 患者的硫胺素缺乏症。
