Ilanga Malynn, Heard Jessica C, McClintic James, Lewis Danielle, Martin Gregory, Horn Carah, Khorgami Zhamak, Richards Jesse, Chow Geoffrey S, Lim Robert B
Department of Surgery, University of Oklahoma at Tulsa, 1919 S. Wheeling Ave. Ste. 600, Tulsa, OK, 74104, USA.
Department of Surgery, Methodist Richardson Medical Center, 2831 E President George Bush Hwy, Richardson, TX, 75082, USA.
Surg Endosc. 2023 Dec;37(12):9509-9513. doi: 10.1007/s00464-023-10387-1. Epub 2023 Sep 12.
Body mass index (BMI) > 50 kg/m is associated with relatively increased morbidity and mortality with bariatric surgery (BS). There is reluctance to consider these patients operative candidates without preoperative weight loss. Glucagon-like peptide-1 (GLP-1) agonists have demonstrated effective weight loss in the post-BS setting. This study aims to determine the safety and efficacy of GLP-1 agonists in the pre-habilitation of patients with BMI > 50 kg/m.
This is a retrospective review of bariatric surgery patients with BMI > 50 kg/m from a single bariatric center. Patients were compared by preoperative GLP-1 therapy status. All patients received medical, surgical, psychiatric, and nutritional evaluation and counseling. Preoperative BMI, change in weight from program intake until surgery, time to surgery, and perioperative complications were evaluated.
31 patients were included in the analysis. 18 (58%) received a GLP-1 agonist preoperatively. GLP-1 agonist use was associated with a 5.5 ± 3.2-point reduction in BMI compared to 2.9 ± 2.4 amongst controls (p = 0.026). There was no difference in the mean length of time in the bariatric program prior to surgery between groups (p = 0.332). There were no reported complications related to GLP-1 use in the preoperative setting and no difference in perioperative complications between groups (p = 0.245).
GLP-1 agonist use in patients with a BMI > 50 kg/m results in significantly more weight loss prior to bariatric surgery, without increased time to surgery or complication rate. Further study is required to evaluate the long-term impact of preoperative GLP-1 agonist use prior to bariatric surgery. This therapy may improve perioperative and long-term outcomes in the very high-risk BMI population.
体重指数（BMI）>50kg/m²与减重手术（BS）的发病率和死亡率相对增加相关。在没有术前体重减轻的情况下，人们不愿意将这些患者视为手术候选者。胰高血糖素样肽-1（GLP-1）激动剂已在减重手术后的环境中证明了有效的体重减轻。本研究旨在确定GLP-1激动剂在BMI>50kg/m²患者术前康复中的安全性和有效性。
这是一项对来自单个减重中心的BMI>50kg/m²的减重手术患者的回顾性研究。根据术前GLP-1治疗状态对患者进行比较。所有患者均接受了医学、手术、精神和营养评估及咨询。评估了术前BMI、从项目入组到手术期间的体重变化、手术时间和围手术期并发症。
31名患者纳入分析。18名（58%）患者术前接受了GLP-1激动剂治疗。与对照组的2.9±2.4相比，使用GLP-1激动剂使BMI降低了5.5±3.2个点（p=0.026）。两组之间手术前在减重项目中的平均时间长度没有差异（p=0.332）。在术前环境中没有报告与使用GLP-1相关的并发症，两组之间围手术期并发症也没有差异（p=0.245）。
在BMI>50kg/m²的患者中使用GLP-1激动剂可在减重手术前显著减轻更多体重，而不会增加手术时间或并发症发生率。需要进一步研究来评估术前使用GLP-1激动剂对减重手术的长期影响。这种治疗可能会改善极高风险BMI人群的围手术期和长期结局。
