Ba Djibril M, Hu Antoinette, Shen Chan, Leslie Douglas L, Chinchilli Vernon M, Rogers Ann M, Al-Shaar Laila
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Surg Obes Relat Dis. 2023 Sep;19(9):935-943. doi: 10.1016/j.soard.2023.02.013. Epub 2023 Feb 23.
Bariatric surgery (BS) can lead to postoperative nutritional deficiencies (NDs) due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying NDs' prevalence over time and their predictors among patients undergoing BS.
To characterize time trends and predictors of postoperative NDs.
This retrospective cohort study used the U.S. IBM MarketScan commercial claims database (2005-2019) to include adults who underwent BS with continuous enrollment.
BS included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch. NDs included protein malnutrition, deficiencies in vitamins D and B12, and anemia that may be related to NDs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NDs across BS types after adjusting for other patient factors.
Within 83,635 patients (mean age [SD], 44.5 [9.5] yr; 78% female patients), 38.7%, 32.9%, and 28% underwent RYGB, SG, and AGB, respectively. Age-adjusted prevalence of any NDs within 1, 2, and 3 years after BS ranged from 23%, 34%, and 42%, respectively (in 2006) to 44%, 54%, and 61%, respectively (in 2016). Relative to the AGB group, the adjusted OR of any 3-year postoperative NDs was 3.00 (95% CI, 2.89-3.11) for the RYGB group and 2.42 (95% CI, 2.33-2.51) for the SG group.
RYGB and SG were associated with 2.4- to 3.0-fold odds of developing 3-year postoperative NDs compared with AGB, independent of baseline ND status. Pre- and postoperative nutritional assessments are recommended for all patients undergoing BS to optimize postoperative outcomes.
由于限制和吸收不良机制，减重手术（BS）可导致术后营养缺乏（NDs），但量化NDs随时间的患病率及其在接受BS手术患者中的预测因素的文献有限。
描述术后NDs的时间趋势和预测因素。
这项回顾性队列研究使用美国IBM MarketScan商业索赔数据库（2005 - 2019年）纳入持续参保的接受BS手术的成年人。
BS包括Roux - Y胃旁路术（RYGB）、袖状胃切除术（SG）、可调节胃束带术（AGB）和胆胰转流十二指肠转位术。NDs包括蛋白质营养不良、维生素D和B12缺乏以及可能与NDs相关的贫血。在调整其他患者因素后，使用逻辑回归模型估计不同BS类型术后NDs的比值比（ORs）和95%置信区间（CIs）。
在83635例患者中（平均年龄[标准差]，44.5[9.5]岁；78%为女性患者），分别有38.7%、32.9%和28%的患者接受了RYGB、SG和AGB手术。BS术后1年、2年和3年内任何NDs的年龄调整患病率分别从2006年的23%、34%和42%到2016年的44%、54%和61%不等。相对于AGB组，RYGB组术后3年任何NDs的调整后OR为3.00（95%CI，2.89 - 3.11），SG组为2.42（95%CI，2.33 - 2.51）。
与AGB相比，RYGB和SG术后3年发生NDs的几率高2.4至3.0倍，与基线ND状态无关。建议对所有接受BS手术的患者进行术前和术后营养评估，以优化术后结局。
