Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Obes Surg. 2019 Dec;29(12):3854-3859. doi: 10.1007/s11695-019-04055-4.
Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers.
We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders.
There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54-2.56) and non-smoking (HR, 1.93; 95% CI, 1.12-3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction = .67).
Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.
减重手术与全因死亡率降低相关，但许多研究排除了吸烟者。我们旨在确定肥胖症手术与死亡率之间的关联在吸烟者和非吸烟者之间是否存在差异。
我们在一家大型以色列综合支付者/提供者医疗保健组织中进行了一项回顾性队列研究。共选择了 7747 名 2005 年 1 月 1 日至 2014 年 12 月 31 日期间接受过减重手术的成年患者，并与非手术患者进行了比较（并使用连续/同时分层匹配按年龄、性别、糖尿病和 BMI 进行匹配）。本研究共纳入 30742 名患者，中位随访时间为 4.3 年，随访丢失率低于 1%。从电子健康记录中确定了减重手术类型（胃带、Roux-en-Y 胃旁路或袖状胃切除术）和吸烟状况。在吸烟和不吸烟亚组中比较了匹配的手术和非手术患者的全因死亡率，并调整了关键潜在混杂因素。
在吸烟（HR，1.99；95%CI，1.54-2.56）和非吸烟（HR，1.93；95%CI，1.12-3.34）亚组中，未接受减重手术与死亡率显著相关。尽管吸烟者总体死亡率较高（吸烟者为 2.6%，而非吸烟者为 1.7%），但吸烟者和非吸烟者之间的死亡率危险比（与匹配的非手术患者相比手术患者）差异无统计学意义（p 交互 = .67）。
在吸烟者和非吸烟者中，减重手术与死亡率显著降低相关。
