Zhang James B, Tamboli Robyn A, Albaugh Vance L, Williams David B, Kilkelly Donna M, Grijalva Carlos G, Shibao Cyndya A
Department of Surgery Vanderbilt University Medical Center Nashville Tennessee.
Department of Health Policy Vanderbilt University Medical Center Nashville Tennessee.
Obes Sci Pract. 2019 Dec 6;6(1):76-83. doi: 10.1002/osp4.383. eCollection 2020 Feb.
Every year, over 200 000 individuals undergo bariatric surgery for the treatment of extreme obesity in the United States. Several retrospective studies describe the occurrence of orthostatic intolerance (OI) syndrome after bariatric surgery. However, the incidence of this syndrome remains unknown.
We used a prospective, de-identified registry of 4547 patients who have undergone bariatric surgery at Vanderbilt to identify cases of new-onset OI. Structured chart reviews were conducted for all subjects who reported new-onset OI post surgery. Cases of OI were confirmed using an operational case definition developed by the Vanderbilt Autonomic Dysfunction Center, and autonomic function tests results were examined for evidence of impaired autonomic function. The cumulative incidence of post-bariatric surgery OI syndrome was estimated using a life table.
Seven hundred forty-one of 4547 (16.3%) patients included in our cohort reported new OI symptoms after surgery. After the chart review, we confirmed the presence of post-bariatric surgery OI syndrome in 85 patients, 14 with severe OI requiring pressor agents. At 5 years post surgery, follow-up is reduced to 15%; the unadjusted 5-year prevalence of OI was 1.9%. The cumulative incidence of OI syndrome adjusted for loss of follow-up was 4.2%. Most OI cases developed during weight-stable months (±5 kg). At the time of identification, 13% of OI cases showed evidence of impaired sympathetic vasoconstrictor activity.
OI is frequent in the bariatric population, affecting 4.2% of patients within the first 5 years postoperatively. In 13% of post-bariatric surgery OI patients, there was evidence of impaired sympathetic vasoconstriction activity.
在美国，每年有超过20万人接受减肥手术以治疗极度肥胖。几项回顾性研究描述了减肥手术后体位性不耐受（OI）综合征的发生情况。然而，该综合征的发病率仍然未知。
我们使用了范德比尔特减肥手术患者的前瞻性、匿名登记册，以识别新发OI病例。对所有报告术后新发OI的受试者进行结构化病历审查。使用范德比尔特自主神经功能障碍中心制定的操作性病例定义来确诊OI病例，并检查自主神经功能测试结果以寻找自主神经功能受损的证据。使用生命表估计减肥手术后OI综合征的累积发病率。
我们队列中的4547名患者中有741名（16.3%）报告术后出现新发OI症状。经过病历审查，我们确认85例患者存在减肥手术后OI综合征，其中14例严重OI需要使用升压药。术后5年，随访率降至15%；未经调整的OI 5年患病率为1.9%。经随访损失调整后的OI综合征累积发病率为4.2%。大多数OI病例在体重稳定的月份（±5千克）出现。在确诊时，13%的OI病例显示出交感神经血管收缩活动受损的证据。
OI在减肥人群中很常见，在术后头5年内影响4.2%的患者。在13%的减肥手术后OI患者中，有交感神经血管收缩活动受损的证据。
