Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Departments of Health Services and Pharmacy, University of Washington, Seattle.
JAMA Netw Open. 2022 Sep 1;5(9):e2233843. doi: 10.1001/jamanetworkopen.2022.33843.
The comparative effectiveness of the most common operations in the long-term management of dyslipidemia is not clear.
To compare 4-year outcomes associated with vertical sleeve gastrectomy (VSG) vs Roux-en-Y gastric bypass (RYGB) for remission and relapse of dyslipidemia.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective comparative effectiveness study was conducted from January 1, 2009, to December 31, 2016, with follow-up until December 31, 2018. Participants included patients with dyslipidemia at the time of surgery who underwent VSG (4142 patients) or RYGB (2853 patients). Patients were part of a large integrated health care system in Southern California. Analysis was conducted from January 1, 2018, to December 31, 2021.
RYGB and VSG.
Dyslipidemia remission and relapse were assessed in each year of follow-up for as long as 4 years after surgery.
A total of 8265 patients were included, with a mean (SD) age of 46 (11) years; 6591 (79.8%) were women, 3545 (42.9%) were Hispanic, 1468 (17.8%) were non-Hispanic Black, 2985 (36.1%) were non-Hispanic White, 267 (3.2%) were of other non-Hispanic race, and the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 44 (7) at the time of surgery. Dyslipidemia outcomes at 4 years were ascertained for 2168 patients (75.9%) undergoing RYGB and 3999 (73.9%) undergoing VSG. Remission was significantly higher for those who underwent RYGB (824 [38.0%]) compared with VSG (1120 [28.0%]) (difference in the probability of remission, 0.10; 95% CI, 0.01-0.19), with no differences in relapse (455 [21.0%] vs 960 [24.0%]). Without accounting for relapse, remission of dyslipidemia after 4 years was 58.9% (1279) for those who underwent RYGB and 51.9% (2079) for those who underwent VSG. Four-year differences between operations were most pronounced for patients 65 years or older (0.39; 95% CI, 0.27-0.51), those with cardiovascular disease (0.43; 95% CI, 0.24-0.62), or non-Hispanic Black patients (0.13; 95% CI, 0.01-0.25) and White patients (0.13; 95% CI, 0.03-0.22).
In this large, racially and ethnically diverse cohort of patients who underwent bariatric and metabolic surgery in clinical practices, RYGB was associated with higher rates of dyslipidemia remission after 4 years compared with VSG. However, almost one-quarter of all patients experienced relapse, suggesting that patients should be monitored closely throughout their postoperative course to maximize the benefits of these operations for treatment of dyslipidemia.
最常见的血脂异常长期管理操作的相对疗效尚不清楚。
比较垂直袖状胃切除术（VSG）与 Roux-en-Y 胃旁路术（RYGB）在血脂异常缓解和复发方面的 4 年结果。
设计、地点和参与者：这是一项回顾性比较有效性研究，于 2009 年 1 月 1 日至 2016 年 12 月 31 日进行，随访至 2018 年 12 月 31 日。参与者包括在手术时患有血脂异常的患者，他们接受了 VSG（4142 例）或 RYGB（2853 例）。患者来自南加州一个大型综合性医疗保健系统。分析于 2018 年 1 月 1 日至 2021 年 12 月 31 日进行。
RYGB 和 VSG。
在手术后的最长 4 年内，每年评估血脂异常缓解和复发情况。
共纳入 8265 例患者，平均（SD）年龄为 46（11）岁；6591 例（79.8%）为女性，3545 例（42.9%）为西班牙裔，1468 例（17.8%）为非西班牙裔黑人，2985 例（36.1%）为非西班牙裔白人，267 例（3.2%）为其他非西班牙裔种族，手术时平均（SD）体重指数（体重以千克为单位除以身高以米为单位计算）为 44（7）。对 2168 例（75.9%）接受 RYGB 和 3999 例（73.9%）接受 VSG 的患者进行了 4 年的血脂异常结果评估。RYGB 组（824 [38.0%]）的缓解率明显高于 VSG 组（1120 [28.0%]）（缓解概率差异，0.10；95%CI，0.01-0.19），两组复发率无差异（455 [21.0%] vs 960 [24.0%]）。不考虑复发，RYGB 术后 4 年血脂异常缓解率为 65 岁及以上患者（58.9%[1279]）和 VSG 术后患者（51.9%[2079]）。在 65 岁及以上（0.39；95%CI，0.27-0.51）、心血管疾病（0.43；95%CI，0.24-0.62）或非西班牙裔黑人患者（0.13；95%CI，0.01-0.25）和白人患者（0.13；95%CI，0.03-0.22）中，手术间差异最为显著。
在这项在临床实践中接受减重和代谢手术的大型、种族和民族多样化的患者队列中，与 VSG 相比，RYGB 术后 4 年血脂异常缓解率更高。然而，近四分之一的患者出现复发，这表明患者应在整个术后过程中密切监测，以最大限度地提高这些手术治疗血脂异常的益处。
