Kim Jaewhan, Kelley Joshua, Ikramuddin Sayeed, Magel Jake, Richards Nathan, Adams Ted
Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA.
J Gastrointest Surg. 2023 May;27(5):895-902. doi: 10.1007/s11605-023-05580-5. Epub 2023 Jan 23.
Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and may reduce mortality. Several factors are associated with higher mortality following MBS. The purpose of this study was to examine whether pre-operative arthritis was associated with long-term mortality following MBS.
Using a retrospective cohort design, subjects who underwent MBS were identified from the Utah Bariatric Surgery Registry. These subjects were linked to the Utah Population Database. State death records from 1998 through 2021 were used to identify deaths following MBS. ICD-9/10 diagnosis codes were used to identify a pre-operative diagnosis of arthritis and to classify the cause of death. All causes of death, internal cause of death (e.g., diabetes, heart disease), and external cause of death (e.g., suicide) were defined as outcomes. Entropy balancing (EB) was applied to create weights to balance the baseline characteristics of the two groups. Weighted Cox proportional hazards regression was used to evaluate the association of pre-operative arthritis with long-term mortality following MBS.
The final sample included 15,112 patients. Among them, 36% had a pre-operative arthritis diagnosis. Average (SD) age was 48(12) years old at surgery, and 75% were female. Patients with pre-operative arthritis had 25% (p < 0.01) and 26% (p < 0.01) higher risk of all cause of death and internal cause of death, respectively, compared to patients without pre-operative arthritis.
Individuals with arthritis prior to MBS may have higher hazard of long-term mortality than those without pre-operative arthritis.
代谢与减重手术（MBS）是治疗肥胖症的有效方法，且可能降低死亡率。有几个因素与MBS术后较高的死亡率相关。本研究的目的是探讨术前关节炎是否与MBS术后的长期死亡率相关。
采用回顾性队列设计，从犹他州减重手术登记处识别接受MBS的受试者。这些受试者与犹他州人口数据库相链接。使用1998年至2021年的州死亡记录来识别MBS术后的死亡情况。国际疾病分类第九版/第十版（ICD-9/10）诊断代码用于识别术前关节炎诊断并对死亡原因进行分类。所有死亡原因、内部死亡原因（如糖尿病、心脏病）和外部死亡原因（如自杀）均被定义为结局。应用熵平衡（EB）来创建权重以平衡两组的基线特征。加权Cox比例风险回归用于评估术前关节炎与MBS术后长期死亡率之间的关联。
最终样本包括15112名患者。其中，36%有术前关节炎诊断。手术时平均（标准差）年龄为48（12）岁，75%为女性。与无术前关节炎的患者相比，术前有关节炎的患者全因死亡风险和内部死亡原因风险分别高25%（p<0.01）和26%（p<0.01）。
MBS术前患有关节炎的个体可能比无术前关节炎的个体有更高的长期死亡风险。
