Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Torino, 10126 Torino, Italy.
Rehabilitation Medicine Unit, IRCCS Istituto Auxologico Italiano Piancavallo (Verbania), 28921 Oggebbio, Italy.
Nutrients. 2021 Sep 9;13(9):3150. doi: 10.3390/nu13093150.
Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18-60 years, BMI ≥ 40 kg/m) admitted during 2002-2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27-0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68-0.88 and HR = 0.78; 0.63-0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.
减重手术（BS）在特定的重度肥胖患者亚组中具有生存获益；否则，其对住院的影响仍不确定。我们评估了 BS 对重度肥胖患者死亡率和住院的长期影响。这是一项回顾性队列研究，纳入了 2002 年至 2018 年期间在意大利辅助研究所就诊的所有居住在皮埃蒙特的患者（年龄 18-60 岁，BMI≥40kg/m²）。考虑到手术是一个随时间变化的变量，我们对死亡率和住院的 BS 调整后的危险比（HR）进行了估计。在 2285 名患者中，有 331 名（14.5%）接受了 BS；64.4%接受了袖状胃切除术（SG），18.7%接受了 Roux-en-Y 胃旁路术（RYGB），16.9%接受了可调胃束带术（AGB）。10 年随访后，BS 组和非 BS 组分别有 10（3%）和 233（12%）名患者死亡（HR=0.52；95%CI 0.27-0.98，多变量 Cox 比例风险回归模型）。在接受 SG 或 RYGB 的患者中，BS 组的住院概率明显低于非 BS 组（HR=0.77；0.68-0.88 和 HR=0.78；0.63-0.98）。当仅比较 BS 组的住院风险时，发现所有 BS 类型手术后的风险均显著降低。总之，BS 可显著降低 10 年随访后全因死亡率和住院风险。
