减重手术与心肌梗死和中风后死亡率降低相关：一项全国性研究。
Bariatric surgery is associated with a lower rate of death after myocardial infarction and stroke: A nationwide study.
机构信息
Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
出版信息
Diabetes Obes Metab. 2019 Sep;21(9):2058-2067. doi: 10.1111/dom.13765. Epub 2019 Jun 17.
AIM
To assess the potential protective effect of bariatric surgery on mortality after myocardial infarction (MI) or cerebrovascular accident (CVA).
MATERIALS AND METHODS
Using the National Inpatient Sample (2007-2014), 2218 patients with a principal discharge diagnosis of acute MI and 2168 patients with ischaemic CVA who also had history of prior bariatric surgery were identified. Utilizing propensity scores, these patients were matched 1:5 with patients who had similar principal diagnoses but no history of bariatric surgery (controls). Control group-1 included participants with obesity (BMI ≥ 35 kg/m ) only and participants in control group-2 were matched according to post-surgery BMI with the bariatric surgery group. The primary and secondary endpoints were in-hospital all-cause mortality and length of hospital stay, respectively. Outcomes after MI and CVA were separately compared among groups in multivariate regression models.
RESULTS
A total of 48 300 (weighted) participants were included in the analysis. The distribution of covariates was well balanced after propensity matching. Mortality rates after MI were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.85% vs 3.03%; odds ratio (OR), 0.61; 95% confidence interval (CI), 0.44-0.86; P = 0.004) and with control group-2 (2.00% vs 3.26%; OR, 0.62; 95% CI, 0.44-0.88; P = 0.008). Similarly, in-hospital mortality rates after CVA were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.43% vs 2.74%; OR, 0.54; 95% CI, 0.37-0.79; P = 0.001) and with control group-2 (1.54% vs 2.59%; OR, 0.61; 95% CI, 0.41-0.91; P = 0.015). Furthermore, length of stay was significantly shorter in the bariatric surgery group for all comparisons (P < 0.001).
CONCLUSION
Prior bariatric surgery is associated with significant protective effect on survival after MI and CVA.
目的
评估减重手术对心肌梗死（MI）或脑血管意外（CVA）后死亡率的潜在保护作用。
材料与方法
利用国家住院患者样本（2007-2014 年），确定了 2218 例主要出院诊断为急性 MI 和 2168 例缺血性 CVA 且有减重手术史的患者。通过倾向评分，将这些患者与具有类似主要诊断但无减重手术史的患者（对照组）进行 1:5 匹配。对照组 1 仅包括肥胖症（BMI≥35kg/m²）患者，对照组 2 则根据手术后 BMI 与减重手术组相匹配。主要和次要终点分别为住院期间全因死亡率和住院时间。在多变量回归模型中分别比较 MI 和 CVA 后各组的结果。
结果
共有 48300 名（加权）参与者被纳入分析。倾向匹配后，协变量的分布得到了很好的平衡。与对照组 1（3.03%；比值比（OR）0.61；95%置信区间（CI）0.44-0.86；P=0.004）和对照组 2（3.26%；OR 0.62；95%CI 0.44-0.88；P=0.008）相比，有减重手术史的 MI 患者的死亡率明显更低。同样，与对照组 1（2.74%；OR 0.54；95%CI 0.37-0.79；P=0.001）和对照组 2（2.59%；OR 0.61；95%CI 0.41-0.91；P=0.015）相比，有减重手术史的 CVA 患者的住院期间死亡率明显更低。此外，所有比较中减重手术组的住院时间都明显缩短（P<0.001）。
结论
减重手术史与 MI 和 CVA 后生存的显著保护作用相关。
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