Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France.
UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France.
Obes Surg. 2022 May;32(5):1486-1497. doi: 10.1007/s11695-022-05937-w. Epub 2022 Mar 10.
Few studies have evaluated the association between non-clinical determinants (socioeconomic status and geographic accessibility to healthcare) and the outcomes of bariatric surgery, with conflicting results. This study aimed to evaluate this association.
The medical records of 1599 consecutive patients who underwent either laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between June 2005 and December 2017 were retrieved. All relevant data, including patient characteristics, biometric values before and after surgery, related medical problems, surgical history, medications, and habitus, for each patient were prospectively collected in a database. Logistic regressions were used to assess the influence of non-clinical determinants on surgical indications and complications. Multilevel linear or logistic regression was used to evaluate the influence of non-clinical determinants on long-term %TWL and the probability to achieve adequate weight loss (defined as a %TWL > 20% at 12 months).
Analysis of the 1599 medical records revealed that most geographically isolated patients were more likely to have undergone laparoscopic Roux-en-Y gastric bypass (odds ratio: 0.97; 95% confidence interval: 0.94 to 0.99; P = 0.018) and had a greater likelihood of adequate weight loss (β: 0.03; 95% CI: 0.01 to 0.05; P = 0.021). Conversely, socioeconomic status (measured by the European Deprivation Index) did not affect outcomes following bariatric surgery.
Geographical health isolation is associated with a higher probability to achieve adequate weight loss after 1 year of follow-up, while neither health isolation nor socioeconomic deprivation is associated with post-operative mortality and morbidity. This results suggests that bariatric surgery is a safe and effective tool for weight loss despite socioeconomic deprivation.
很少有研究评估非临床决定因素（社会经济地位和获得医疗保健的地理便利性）与减重手术结果之间的关系，且这些研究的结果相互矛盾。本研究旨在评估这种关联。
回顾了 2005 年 6 月至 2017 年 12 月期间连续接受腹腔镜 Roux-en-Y 胃旁路术或腹腔镜袖状胃切除术的 1599 例患者的病历。每位患者的相关数据，包括患者特征、手术前后的人体测量值、相关医疗问题、手术史、药物和体型，均前瞻性地收集在数据库中。使用逻辑回归评估非临床决定因素对手术适应证和并发症的影响。使用多水平线性或逻辑回归评估非临床决定因素对长期 %TWL 和实现足够减重的概率（定义为 12 个月时 %TWL > 20%）的影响。
对 1599 份病历的分析表明，大多数地理位置偏远的患者更有可能接受腹腔镜 Roux-en-Y 胃旁路术（优势比：0.97；95%置信区间：0.94 至 0.99；P = 0.018），且更有可能实现足够的减重（β：0.03；95%置信区间：0.01 至 0.05；P = 0.021）。相反，社会经济地位（用欧洲剥夺指数衡量）并不影响减重手术后的结果。
地理上的健康隔离与 1 年后实现足够减重的可能性更高相关，而健康隔离和社会经济剥夺均与术后死亡率和发病率无关。这些结果表明，尽管存在社会经济剥夺，减重手术仍然是一种安全有效的减重工具。
