Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Division of Surgery, Mayo Clinic, Rochester, MN, USA.
Obes Surg. 2019 Feb;29(2):579-584. doi: 10.1007/s11695-018-3565-5.
Obesity has become a global epidemic. Bariatric surgery remains the most successful modality for producing sustained weight loss. Attrition rates after bariatric surgery are currently reported between 3 and 63% depending on the type of bariatric operation and the length of follow-up provided by the bariatric surgery team. It is currently unknown if patient attrition from bariatric surgery programs impact clinical outcomes. The availability of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the Mayo Clinic Midwest unified electronic medical record (EMR) provide a unique opportunity to explore this topic.
Raw data was downloaded from MBSAQIP database for all laparoscopic Roux-en-Y gastric bypass (LRYGB) cases between May 1, 2008 and January 8, 2015 (N = 1242). Baseline weight and preexisting comorbidities (type 2 diabetes, hypertension, and hyperlipidemia) were recorded using the MBSAQIP database and the EMR. Current weight and comorbidity data (type 2 diabetes, hypertension, and hyperlipidemia) were subsequently collected at the time closest to the patient's surgical anniversary dates during the following assessment periods: years 1, 2, and 3 after surgery. Mean percentage total weight loss (TWL) was calculated at each time frame for each patient. Data was summarized using descriptive statistics, including counts and percentages for categorical variables by either year or year and location.
The number of patients seen by the bariatric surgery practice (BSP) compared to those seen by other providers within our practice (attrition to bariatric surgery practice (ABSP)) was highest in year 1 and reduced each subsequent year (year 1: BSP N = 740, ABSP N = 166, year 2: BSP N = 425, ABSP N = 309, and year 3: BSP N = 235, ABSP N = 325). The mean TWL in the BSP and ABSP groups at year 1 was 31.84% versus 30.19%, at year 2 was 31.34% versus 29.67%, and at year 3 was 29.01% versus 27.71% respectively. Differences were statistically significant between groups at years 1 and 2 (p < 0.05). A statistically significant difference was not found in year 3 despite a trend towards higher TWL in the BSP group. Among all patients, statistically significant differences (p < 0.0001) were observed between baseline and years 1, 2, and 3 for type 2 diabetes, hypertension, and hyperlipidemia.
Our study confirms the problem of patient attrition to follow up at our BSP. It is also the first to suggest a difference in weight loss outcomes among patients seen in BSP compared to those seen by other providers (ABSP) at 1 and 2 years after Roux-en-Y gastric bypass (LRYGB). The potential implications of this observation on long-term weight maintenance after LRYGB and the impact on metabolic comorbidities remain unknown but warrant further investigation. It also warrants the development of strategies to improve patient retention in BSP and/or engagement of medical providers to achieve that end.
肥胖已成为全球性流行病。减重手术仍然是产生持续体重减轻的最成功方式。根据减重手术类型和减重手术团队提供的随访时间长短，减重手术后的流失率目前报告在 3%至 63%之间。目前尚不清楚减重手术项目的患者流失是否会影响临床结果。代谢和减重手术认证和质量改进计划（MBSAQIP）和梅奥诊所中西部统一电子病历（EMR）的可用性为探讨这一主题提供了独特的机会。
从 MBSAQIP 数据库下载 2008 年 5 月 1 日至 2015 年 1 月 8 日期间所有腹腔镜 Roux-en-Y 胃旁路术（LRYGB）病例的原始数据（N=1242）。使用 MBSAQIP 数据库和 EMR 记录基线体重和既往并存疾病（2 型糖尿病、高血压和高脂血症）。随后在以下评估期内，在最接近患者手术周年日期的时间收集当前体重和并存疾病数据（2 型糖尿病、高血压和高脂血症）：手术后 1、2 和 3 年。为每位患者在每个时间框架计算平均总体重减轻百分比（TWL）。使用描述性统计数据总结数据，包括按年或年和地点分类的变量的计数和百分比。
在我们的实践中，与其他提供者一起看到的接受减重手术实践（BSP）的患者数量（相对于我们实践中看到的其他提供者（ABSP））在第 1 年最高，随后每年减少（第 1 年：BSP N=740，ABSP N=166，第 2 年：BSP N=425，ABSP N=309，第 3 年：BSP N=235，ABSP N=325）。BSP 和 ABSP 组在第 1 年的平均 TWL 为 31.84%，而第 2 年为 31.34%，第 3 年为 29.01%，第 2 年为 29.67%。第 1 年和第 2 年组间差异具有统计学意义（p<0.05）。尽管 BSP 组的 TWL 呈上升趋势，但第 3 年未发现统计学差异。在所有患者中，基线与第 1、2 和 3 年相比，2 型糖尿病、高血压和高脂血症均存在统计学显著差异（p<0.0001）。
我们的研究证实了我们 BSP 随访患者流失的问题。这也是第一个表明在 Roux-en-Y 胃旁路术（LRYGB）后 1 年和 2 年，与其他提供者（ABSP）一起看到的患者与 BSP 中看到的患者相比，减肥效果存在差异。这种观察对 LRYGB 后长期体重维持的潜在影响以及对代谢并存疾病的影响尚不清楚，但值得进一步研究。这也需要制定改善 BSP 中患者保留率和/或参与医疗提供者以实现这一目标的策略。
