Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Graduate School of Psychology, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil.
Obes Surg. 2021 Mar;31(3):1030-1037. doi: 10.1007/s11695-020-05103-0. Epub 2020 Nov 14.
There are no criteria to establish priority for bariatric surgery candidates in the public health system in several countries. The aim of this study is to identify preoperative characteristics that allow predicting the success after bariatric surgery.
Four hundred and sixty-one patients submitted to Roux-en-Y gastric bypass were included. Success of the surgery was defined as the sum of five outcome variables, assessed at baseline and 12 months after the surgery: excess weight loss, use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) as a treatment for obstructive sleep apnea (OSA), daily number of antidiabetics, daily number of antihypertensive drugs, and all-cause mortality. Partial least squares (PLS) regression and multiple linear regression were performed to identify preoperative predictors. We performed a 90/10 split of the dataset in train and test sets and ran a leave-one-out cross-validation on the train set and the best PLS model was chosen based on goodness-of-fit criteria.
The preoperative predictors of success after bariatric surgery included lower age, presence of non-alcoholic fatty liver disease and OSA, more years of CPAP/BiPAP use, negative history of cardiovascular disease, and lower number of antihypertensive drugs. The PLS model displayed a mean absolute percent error of 0.1121 in the test portion of the dataset, leading to accurate predictions of postoperative outcomes.
This success index allows prioritizing patients with the best indication for the procedure and could be incorporated in the public health system as a support tool in the decision-making process.
在一些国家的公共卫生系统中，没有为减重手术候选人确定优先顺序的标准。本研究旨在确定术前特征，以便预测减重手术后的成功。
共纳入 461 例接受 Roux-en-Y 胃旁路术的患者。手术成功定义为手术前后 5 个结果变量的总和：超重减轻、使用持续气道正压通气（CPAP）或双水平气道正压通气（BiPAP）治疗阻塞性睡眠呼吸暂停（OSA）、抗糖尿病药物的日剂量、抗高血压药物的日剂量以及全因死亡率。采用偏最小二乘法（PLS）回归和多元线性回归分析确定术前预测指标。我们将数据集分为 90/10 的训练集和测试集，并对训练集进行留一法交叉验证，根据拟合优度标准选择最佳 PLS 模型。
减重手术后成功的术前预测指标包括年龄较低、存在非酒精性脂肪性肝病和 OSA、CPAP/BiPAP 使用年限较长、无心血管疾病病史以及使用的降压药较少。PLS 模型在数据集的测试部分的平均绝对百分比误差为 0.1121，可准确预测术后结果。
该成功指数可优先考虑具有最佳手术适应证的患者，并可作为决策过程中的支持工具纳入公共卫生系统。
