既往急性冠状动脉事件或心力衰竭患者行减重手术的安全性：全国队列研究。
Safety of bariatric surgery in patients with previous acute coronary events or heart failure: nationwide cohort study.
机构信息
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
出版信息
BJS Open. 2022 May 2;6(3). doi: 10.1093/bjsopen/zrac083.
BACKGROUND
Metabolic (bariatric) surgery for patients with severe obesity and pre-existing heart disease has been reported to reduce the risk for cardiovascular events and mortality; however, concerns of short- and mid-term complications may limit the utility of metabolic surgery for these patients.
METHOD
This was an observational, nationwide, matched study, including all adult patients operated with a primary gastric bypass or sleeve gastrectomy procedure in Sweden from January 2011 until October 2020. Patients with or without previous acute coronary syndrome or heart failure were matched 1:5 using propensity scores. The primary outcome was serious postoperative complications, and secondary outcomes were the occurrence of any short-term complications, mid-term complications, weight loss, and health-related quality of life estimates after surgery.
RESULTS
Of patients who underwent metabolic surgery, 1165 patients with previous acute coronary syndrome or heart failure and 5825 without diagnosed heart disease were included in matched analyses. No difference was seen between the groups at risk for serious postoperative complications within 30 days of surgery (OR 1.33, 95 per cent c.i. 0.95 to 1.86, P = 0.094), whereas heart disease was associated with an increased risk for cardiovascular complications (incidence 1.1 per cent versus 0.2 per cent, P < 0.001). No differences in overall mid-term complications, weight loss, or improvement of health-related quality of life were seen. Pre-existing heart disease was associated with an increased risk for bowel obstruction and strictures (OR 1.89, 95 per cent c.i. 1.20 to 2.99, P = 0.006).
CONCLUSION
Patients with severe obesity and heart disease undergoing metabolic surgery have an increased risk of postoperative cardiovascular complications compared with patients with severe obesity without heart disease. A careful preoperative cardiovascular work-up is needed but patients with severe obesity and heart disease should not be excluded from undergoing metabolic surgery.
背景
对于患有严重肥胖症和先前存在心脏病的患者，代谢（减重）手术已被报道可降低心血管事件和死亡率的风险；然而，对短期和中期并发症的担忧可能会限制代谢手术在这些患者中的应用。
方法
这是一项观察性的、全国性的、匹配的研究，纳入了 2011 年 1 月至 2020 年 10 月期间在瑞典接受初次胃旁路或袖状胃切除术的所有成年患者。使用倾向评分对伴有或不伴有先前急性冠状动脉综合征或心力衰竭的患者进行 1:5 匹配。主要结局是严重术后并发症，次要结局是短期并发症、中期并发症、手术后体重减轻和健康相关生活质量评估的发生。
结果
在接受代谢手术的患者中，1165 例先前患有急性冠状动脉综合征或心力衰竭，5825 例无诊断性心脏病的患者纳入了匹配分析。两组患者在术后 30 天内发生严重术后并发症的风险无差异（比值比 1.33，95%置信区间 0.95 至 1.86，P=0.094），而心脏病与心血管并发症的风险增加相关（发生率为 1.1%与 0.2%，P<0.001）。总体中期并发症、体重减轻或健康相关生活质量的改善无差异。先前存在的心脏病与肠梗阻和狭窄的风险增加相关（比值比 1.89，95%置信区间 1.20 至 2.99，P=0.006）。
结论
与无心脏病的严重肥胖症患者相比，患有严重肥胖症和心脏病的患者行代谢手术后发生术后心血管并发症的风险增加。需要进行仔细的术前心血管检查，但不应将患有严重肥胖症和心脏病的患者排除在代谢手术之外。
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