2 型糖尿病患者行非心脏手术后的减肥手术史与围手术期心血管结局：来自全国住院患者样本数据库的提示。

Prior bariatric surgery and perioperative cardiovascular outcomes following noncardiac surgery in patients with type 2 diabetes mellitus: hint from National Inpatient Sample Database.

机构信息

Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhong Shan Er Lu, Guangzhou, 510080, China.

Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.

出版信息

Cardiovasc Diabetol. 2020 Jul 6;19(1):103. doi: 10.1186/s12933-020-01084-7.

DOI:10.1186/s12933-020-01084-7

PMID:32631310

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7339406/

Abstract

BACKGROUND

Both diabetes and obesity are risk factors for perioperative major adverse events. This study aims to evaluate the association between prior bariatric surgery (prior-BS) and perioperative cardiovascular outcomes following noncardiac surgery in patients with type 2 diabetes mellitus (T2DM).

METHODS

We used the National Inpatient Sample Database to identify T2DM patients undergoing major noncardiac surgery from 2006 to 2014. The primary outcome was major perioperative adverse cardiovascular and cerebrovascular events (MACCEs), which include death, acute myocardial infarction and acute ischaemic stroke. In-hospital outcomes between patients with prior BS and morbid obesity were compared using unadjusted logistic, multivariable logistic and propensity score matching analyses.

RESULTS

A weighted of 1,526,820 patients diagnosed with T2DM who underwent noncardiac surgery were included. The rates of both prior BS and morbid obesity significantly increased during the study period (P < 0.0001). Patients with prior BS were younger, were more likely to be female, and had lower rates of cardiovascular risk factors but had higher rates of smoking, alcohol abuse, anaemia, prior venous thromboembolism and prior percutaneous coronary intervention. The incidence of MACCEs was 1.01% and 3.25% in patients with prior BS and morbid obesity, respectively. After multivariable adjustment, we found that prior BS was associated with a reduced risk of MACCEs (odds ratio [OR] = 0.71; 95% confidence interval [CI] 0.62-0.81), death (OR = 0.64, 95% CI 0.52-0.78), acute kidney injury (OR = 0.66, 95% CI 0.62-0.70) and acute respiratory failure (OR: 0.46; 95% CI 0.42-0.50).

CONCLUSIONS

Prior bariatric surgery in T2DM patients undergoing noncardiac surgery is associated with a lower risk of MACCEs. Prospective studies are needed to verify the benefits of bariatric surgery in patients undergoing noncardiac surgery.

摘要

背景

糖尿病和肥胖都是围手术期主要不良事件的危险因素。本研究旨在评估 2 型糖尿病（T2DM）患者中既往减重手术（prior-BS）与非心脏手术后围手术期心血管结局之间的关系。

方法

我们使用国家住院患者样本数据库，从 2006 年至 2014 年确定接受重大非心脏手术的 T2DM 患者。主要结局是围手术期主要不良心血管和脑血管事件（MACCEs），包括死亡、急性心肌梗死和急性缺血性中风。使用未调整的逻辑、多变量逻辑和倾向评分匹配分析比较有 prior-BS 和病态肥胖的患者的住院期结局。

结果

加权 1,526,820 例诊断为 T2DM 并接受非心脏手术的患者纳入研究。在此期间，prior-BS 和病态肥胖的发生率均显著增加（P < 0.0001）。既往接受过 BS 的患者更年轻，更有可能是女性，心血管危险因素的发生率较低，但吸烟、酗酒、贫血、既往静脉血栓栓塞和既往经皮冠状动脉介入治疗的发生率较高。既往接受过 BS 和病态肥胖的患者的 MACCEs 发生率分别为 1.01%和 3.25%。在多变量调整后，我们发现 prior-BS 与 MACCEs 风险降低相关（比值比 [OR] = 0.71；95%置信区间 [CI] 0.62-0.81）、死亡（OR = 0.64，95%CI 0.52-0.78）、急性肾损伤（OR = 0.66，95%CI 0.62-0.70）和急性呼吸衰竭（OR：0.46；95%CI 0.42-0.50）。