强化术前信息课程（IPIC）和术前减重可使减重手术后长期持续减重：来自三级转诊中心的 11 年结果。
Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre.
机构信息
Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK.
Department of Clinical Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.
出版信息
Surg Endosc. 2024 May;38(5):2689-2698. doi: 10.1007/s00464-024-10791-1. Epub 2024 Mar 22.
INTRODUCTION
Outcomes of long-term (5-10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery.
METHODS
Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%.
RESULTS
Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5-11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up.
CONCLUSIONS
IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.
简介
长期（5-10 年）减肥效果尚未得到充分研究，术前减肥对长期减肥的作用以及其他因素的作用尚不清楚。我们的区域减重服务引入了为期 12 周的强化术前信息课程（IPIC），以优化术前减肥并在减重手术前提供教育。本研究旨在确定术前减肥和强化术前信息课程（IPIC）对长期减重结果和减重手术后持续减重的影响。
方法
数据从减重中心前瞻性收集（2008-2022 年）。体重减轻超过 50%（EWL≥50%）和体重减轻超过 70%（EWL≥70%）被认为是结果衡量标准。生存分析和逻辑回归确定了与总体和持续 EWL≥50%和 EWL≥70%相关的变量。
结果
评估了 339 例患者（中位年龄，49 岁；中位随访时间，7 年[0.5-11 年]；中位 EWL%，49.6%），包括 158 例胃袖状切除术和 161 例胃旁路术。在随访期间，273 例患者（80.5%）和 196 例患者（53.1%）分别实现了 EWL≥50%和 EWL≥70%。在多变量生存分析中，通过 IPIC 实现的术前体重减轻，无论是<10.5%还是>10.5%的 EWL，都与 EWL≥50%（HR 2.23，p<0.001）和 EWL≥70%（HR 3.24，p<0.001）呈正相关。在达到 EWL50%或 EWL70%后中位数为 6.5 年后，271 例中有 56.8%（154/271）持续 EWL50%，168 例中有 50.6%（85/168）持续 EWL70%。通过 IPIC 实现的更高术前体重减轻增加了持续 EWL≥50%（OR，2.36；p=0.013）和 EWL≥70%（OR，2.03；p=0.011）的可能性。
结论
IPIC 和更高的术前体重减轻可改善减重手术后的减重效果，并降低长期随访期间体重反弹的可能性。
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