University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA.
Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Surg Endosc. 2024 May;38(5):2770-2776. doi: 10.1007/s00464-024-10785-z. Epub 2024 Apr 5.
The purpose of this study is to investigate the impact of preoperative comorbidities, including depression, anxiety, type 2 diabetes mellitus, obstructive sleep apnea, hypothyroidism, and the type of surgery on %EBWL (percent estimated body weight loss) in patients 1 year after bariatric surgery. Patients who choose to undergo bariatric surgery often have other comorbidities that can affect both the outcomes of their procedures and the postoperative period. We predict that patients who have depression, anxiety, diabetes mellitus, obstructive sleep apnea, or hypothyroidism will have a smaller change in %EBWL when compared to patients without any of these comorbidities.
Data points were retrospectively collected from the charts of 440 patients from March 2012-December 2019 who underwent a sleeve gastrectomy or gastric bypass surgery. Data collected included patient demographics, select comorbidities, including diabetes mellitus, obstructive sleep apnea, hypothyroidism, depression, and anxiety, and body weight at baseline and 1 year postoperatively. Ideal body weight was calculated using the formula 50 + (2.3 × height in inches over 5 feet) for males and 45.5 + (2.3 × height in inches over 5 feet) for females. Excess body weight was then calculated by subtracting ideal body weight from actual weight at the above forementioned time points. Finally, %EBWL was calculated using the formula (change in weight over 1 year/excess weight) × 100.
Patients who had a higher baseline BMI (p < 0.001), diabetes mellitus (p = 0.026), hypothyroidism (p = 0.046), and who had a laparoscopic sleeve gastrectomy rather than Roux-en-Y gastric bypass (p < 0.001) had a smaller %EBWL in the first year after bariatric surgery as compared to patients without these comorbidities at the time of surgery. Controversially, patients with anxiety or depression (p = 0.73) or obstructive sleep apnea (p = 0.075) did not have a statistically significant difference in %EBWL.
A higher baseline BMI, diabetes mellitus, hypothyroidism, and undergoing laparoscopic sleeve gastrectomy may lead to lower %EBWL in the postoperative period after bariatric surgery. At the same time, patients' mental health status and sleep apnea status were not related to %EBWL. This study provides new insight into which comorbidities may need tighter control in order to optimize weight loss outcomes after bariatric surgery.
本研究旨在探讨术前合并症（包括抑郁症、焦虑症、2 型糖尿病、阻塞性睡眠呼吸暂停、甲状腺功能减退症以及手术类型）对减重手术后 1 年患者的体质量减轻百分比（%EBWL）的影响。选择接受减重手术的患者通常存在其他合并症，这些合并症可能会影响手术结果和术后恢复。我们预测，与没有这些合并症的患者相比，患有抑郁症、焦虑症、糖尿病、阻塞性睡眠呼吸暂停或甲状腺功能减退症的患者，他们的%EBWL 变化会更小。
本研究回顾性收集了 2012 年 3 月至 2019 年 12 月期间接受袖状胃切除术或胃旁路手术的 440 名患者的图表数据点。收集的数据包括患者人口统计学信息、选择合并症（包括糖尿病、阻塞性睡眠呼吸暂停、甲状腺功能减退症、抑郁症和焦虑症）以及术前和术后 1 年的体重。理想体重按男性公式 50+（2.3×身高英寸超过 5 英尺）和女性公式 45.5+（2.3×身高英寸超过 5 英尺）计算。然后，通过从上述各时间点的实际体重中减去理想体重来计算超重体重。最后，通过公式（1 年内体重变化/超重体重）×100 计算%EBWL。
与无这些手术时合并症的患者相比，基线 BMI 较高（p<0.001）、患有糖尿病（p=0.026）、甲状腺功能减退症（p=0.046）和接受腹腔镜袖状胃切除术而不是 Roux-en-Y 胃旁路术（p<0.001）的患者在减重手术后的第 1 年内的%EBWL 较小。相反，患有焦虑症或抑郁症（p=0.73）或阻塞性睡眠呼吸暂停（p=0.075）的患者在%EBWL 方面无统计学差异。
较高的基线 BMI、糖尿病、甲状腺功能减退症和腹腔镜袖状胃切除术可能导致减重手术后的术后时期%EBWL 较低。同时，患者的心理健康状况和睡眠呼吸暂停状况与%EBWL 无关。本研究提供了新的见解，即哪些合并症可能需要更严格的控制，以优化减重手术后的减肥效果。
