Internal Medicine Department, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Obes Surg. 2021 Feb;31(2):755-762. doi: 10.1007/s11695-020-05068-0. Epub 2020 Nov 5.
Data are sparse regarding the survival benefit of bariatric surgery on mortality among persons with diabetes. We aimed to investigate the association of bariatric surgery, compared with usual care, on all-cause mortality in individuals who underwent surgery and matched controls, stratified by the presence of diabetes.
This retrospective cohort study utilized population-based electronic medical record data. Individuals who underwent one of three types of bariatric surgery during 2005-2014 were included. For each surgical patient, three non-surgical individuals were matched according to age, sex, body mass index, and diabetes status. The cohort comprised 9564 individuals with diabetes and 23,976 individuals without diabetes.
During a median follow-up of 4.2 years, adjusted hazard ratios (HRs) for mortality for non-surgery vs. surgery were 2.38 (95%CI: 1.75, 3.26) and 1.73 (95%CI: 1.26, 2.36) among individuals with diabetes and individuals without diabetes, respectively. Considered separately, HRs for mortality for laparoscopic banding, gastric bypass, and laparoscopic sleeve gastrectomy were 2.83 (95%CI: 1.73, 4.63), 2.30 (95%CI: 1.25, 4.25), and 1.89 (95%CI: 1.1, 3.32) among patients with diabetes; and 1.74 (95%CI: 1.20, 2.52), 2.66 (0.81, 8.76), and 1.16 (0.51, 2.65) among patients without diabetes.
The survival advantage of bariatric surgery after a median follow-up of 4.2 years was greater among individuals with than without diabetes for the three types of surgery performed. Longer follow-up is needed to examine the effect on survival in individuals without diabetes who undergo bariatric surgery. These results suggest priority considerations for bariatric surgery candidates.
关于肥胖症手术对糖尿病患者死亡率的生存获益，相关数据较为匮乏。我们旨在研究与常规治疗相比，肥胖症手术对手术患者和匹配对照者（根据糖尿病的存在情况分层）全因死亡率的影响。
这是一项回顾性队列研究，利用基于人群的电子病历数据。纳入在 2005-2014 年期间接受三种类型的减肥手术之一的个体。对于每个手术患者，根据年龄、性别、体重指数和糖尿病状态，匹配三名非手术个体。队列包括 9564 名患有糖尿病的个体和 23976 名没有糖尿病的个体。
在中位数为 4.2 年的随访期间，对于患有糖尿病的个体，非手术与手术相比，死亡率的调整后危险比（HR）分别为 2.38（95%CI：1.75，3.26）和 1.73（95%CI：1.26，2.36）；对于没有糖尿病的个体，非手术与手术相比，死亡率的调整后 HR 分别为 2.83（95%CI：1.73，4.63）和 1.74（95%CI：1.20，2.52）。分别考虑时，腹腔镜带、胃旁路和腹腔镜袖状胃切除术在糖尿病患者中的死亡率 HR 分别为 2.83（95%CI：1.73，4.63）、2.30（95%CI：1.25，4.25）和 1.89（95%CI：1.1，3.32）；在没有糖尿病的患者中，腹腔镜带、胃旁路和腹腔镜袖状胃切除术的死亡率 HR 分别为 1.74（95%CI：1.20，2.52）、2.66（0.81，8.76）和 1.16（0.51，2.65）。
在中位数为 4.2 年的随访后，与没有糖尿病的个体相比，三种手术类型在糖尿病患者中的生存获益更大。需要进行更长时间的随访，以检查接受减肥手术的没有糖尿病的个体对生存的影响。这些结果表明，应优先考虑对肥胖症手术的候选者进行考虑。
