Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA.
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
Obes Surg. 2020 Jan;30(1):111-118. doi: 10.1007/s11695-019-04175-x.
The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) to treat obesity and associated comorbidities, including diabetes mellitus, is well established. As diabetes may add risk to the perioperative period, we sought to characterize perioperative outcomes of these surgical procedures in diabetic patients.
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we identified patients who underwent LSG and LRYGB between 2015 and 2017, grouping by non-diabetics (NDM), non-insulin-dependent diabetics (NIDDM), and insulin-dependent diabetics (IDDM). Primary outcomes included serious adverse events, 30-day readmission, 30-day reoperation, and 30-day mortality. Univariate and multivariable analyses were used to evaluate the outcome in each diabetic cohort.
Multivariable analysis of patients who underwent LSG (with NDM patients as reference) showed higher 30-day mortality (NIDDM AOR = 1.52, p = 0.043; IDDM AOR = 1.91, p = 0.007) and risk of serious adverse events (NIDDM AOR = 1.15, p < 0.001; IDDM AOR = 1.58, p < 0.001) in the diabetic versus NDM groups. Multivariable analysis of patients who underwent LRYGB (with NDM patients as reference) showed higher risk of serious adverse events (NIDDM AOR = 1.09, p = 0.014; IDDM AOR = 1.43, p < 0.001) in the diabetic versus NDM groups.
Diabetics who underwent LSG and LRYGB had higher rates of several perioperative complications compared with non-diabetics. IDDM had a stronger association with several perioperative complications compared with NIDDM. This increase in morbidity and mortality is modest and should be weighed against the real benefits of bariatric surgery in patient with obesity and diabetes mellitus.
腹腔镜袖状胃切除术（LSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）治疗肥胖症及其相关合并症（包括糖尿病）的安全性和有效性已得到充分证实。由于糖尿病可能会增加围手术期的风险，我们试图描述这些手术在糖尿病患者中的围手术期结果。
使用代谢和减重手术认证和质量改进计划（MBSAQIP）数据库，我们确定了 2015 年至 2017 年间接受 LSG 和 LRYGB 的患者，按非糖尿病患者（NDM）、非胰岛素依赖型糖尿病患者（NIDDM）和胰岛素依赖型糖尿病患者（IDDM）分组。主要结局包括严重不良事件、30 天再入院、30 天再次手术和 30 天死亡率。使用单变量和多变量分析评估每个糖尿病队列的结果。
对接受 LSG 的患者（以 NDM 患者为参考）进行多变量分析显示，糖尿病组与 NDM 组相比，30 天死亡率（NIDDM 的比值比 [OR] = 1.52，p = 0.043；IDDM 的 OR = 1.91，p = 0.007）和严重不良事件的风险更高。对接受 LRYGB 的患者（以 NDM 患者为参考）进行多变量分析显示，糖尿病组与 NDM 组相比，严重不良事件的风险更高（NIDDM 的 OR = 1.09，p = 0.014；IDDM 的 OR = 1.43，p < 0.001）。
与非糖尿病患者相比，接受 LSG 和 LRYGB 的糖尿病患者的多种围手术期并发症发生率更高。与 NIDDM 相比，IDDM 与多种围手术期并发症的相关性更强。这种发病率和死亡率的增加是适度的，应权衡肥胖症和糖尿病患者接受减重手术的实际益处。
