McKechnie Tyler, Lee Yung, Hong Dennis, Dionne Joanna, Doumouras Aristithes, Parpia Sameer, Bhandari Mohit, Eskicioglu Cagla
Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address: https://twitter.com/tylermckechnie.
Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. Electronic address: https://twitter.com/YungLeeMD.
Surgery. 2023 Nov;174(5):1168-1174. doi: 10.1016/j.surg.2023.08.011. Epub 2023 Sep 14.
Bariatric surgery is the most effective and sustainable form of weight loss. Bariatric surgery before elective operations for colorectal pathology may improve postoperative outcomes. To compare patients with and without prior bariatric surgery undergoing surgery for colorectal cancer in terms of postoperative morbidity and health care use.
Adult patients undergoing resection for colorectal cancer from 2015 to 2019 were identified from the National Inpatient Sample. Patients were stratified according to their history of bariatric surgery. Propensity score matching with 4:1 nearest-neighbor matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, postoperative length of stay, total admission health care cost, and post-discharge disposition. McNemar's test and Wilcoxon matched-pairs signed-rank test were performed.
After propensity score matching, 1,197 patients without prior bariatric surgery and 376 patients with prior bariatric surgery were included. Patients with prior bariatric surgery had an absolute reduction of 6.5% in overall in-hospital postoperative morbidity (19.1% vs 25.6%, P < .0001), a $5,256 decrease in hospitalization cost ($70,344 vs $75,600, P = .034), and were more likely to be discharged home after their index operation (72.9% vs 63.9%, P < .0001).
Bariatric surgery before surgery for colorectal cancer may be associated with decreased postoperative morbidity and health care use. Bariatric surgery and other forms of rapid and effective weight loss, such as very low-energy diets, should be evaluated further for the optimization of obese patients before nonbariatric abdominal surgery.
减重手术是最有效且可持续的减肥方式。在结直肠疾病择期手术前进行减重手术可能会改善术后结局。比较有或无减重手术史的患者在接受结直肠癌手术时的术后发病率和医疗保健使用情况。
从国家住院患者样本中识别出2015年至2019年接受结直肠癌切除术的成年患者。根据减重手术史对患者进行分层。根据人口统计学、手术和医院特征，采用1:4最近邻匹配的倾向评分匹配法。主要结局是术后发病率。次要结局包括特定系统的术后并发症、术后死亡率、术后住院时间、总住院医疗费用以及出院后处置情况。进行了McNemar检验和Wilcoxon配对符号秩检验。
倾向评分匹配后，纳入了1197例无减重手术史的患者和376例有减重手术史的患者。有减重手术史的患者总体院内术后发病率绝对降低了6.5%（19.1%对25.6%，P <.0001），住院费用减少了5256美元（70344美元对75600美元，P =.034），且在首次手术后更有可能出院回家（72.9%对63.9%，P <.0001）。
结直肠癌手术前进行减重手术可能与术后发病率降低和医疗保健使用减少有关。对于非减重腹部手术前肥胖患者的优化，应进一步评估减重手术和其他快速有效的减肥方式，如极低能量饮食。
