Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France.
UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France.
Surg Endosc. 2023 Nov;37(11):8362-8372. doi: 10.1007/s00464-023-10343-z. Epub 2023 Sep 12.
To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders.
From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities.
Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years.
Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
分析精神疾病患者接受减重手术的安全性和长期结果。
从 2009 年 1 月至 2018 年 12 月,在一家三级中心接受减重手术的患者 n = 961 例。其中,创建了两组患者:一组患有精神疾病的患者(PG)和一组无精神疾病的患者(CG),使用倾向评分匹配(PSM)。主要终点是长期结果,次要终点是术后 90 天的术后发病率、迟发性发病率、精神不良事件的发生和肥胖相关合并症的解决。
PSM 分析允许比较每组 136 例患者,比例为 1:1。PG 组的 TWL%在 2 年时为 32.7%,CG 组为 36.6%(p = 0.002)。PG 组的总体手术发病率高于 CG 组(28%比 17%,p = 0.01)。严重手术并发症无统计学意义(4%比 3%,p = 0.44)。PG 组的精神不良事件明显多于 CG 组。两组在 2 年内肥胖合并症的解决情况相当。
接受减重手术的精神疾病患者报告了大量体重减轻,但其代价是更多非严重手术并发症。此外,鉴于精神不良事件的发生率,对于术前有精神疾病的患者,可能需要进行术后精神随访。