Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK.
Department of Clinical Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.
Surg Endosc. 2024 May;38(5):2689-2698. doi: 10.1007/s00464-024-10791-1. Epub 2024 Mar 22.
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.
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%.
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.
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.
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。
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。
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。
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。
