Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2024 Jun 6;19(6):e0298402. doi: 10.1371/journal.pone.0298402. eCollection 2024.
Bariatric surgery leads to sustained weight loss in a majority of recipients, and also reduces fasting insulin levels and markers of inflammation. We described the long-term associations between bariatric surgery and clinical outcomes including 30 morbidities.
We did a retrospective population-based cohort study of 304,157 adults with severe obesity, living in Alberta, Canada; 6,212 of whom had bariatric surgery. We modelled adjusted time to mortality, hospitalization, surgery and the adjusted incidence/prevalence of 30 new or ongoing morbidities after 5 years of follow-up.
Over a median follow-up of 4.4 years (range 1 day-22.0 years), bariatric surgery was associated with increased risk of hospitalization (HR 1.46, 95% CI 1.41,1.51) and additional surgery (HR 1.42, 95% CI 1.32,1.52) but with a decreased risk of mortality (HR 0.76, 95% CI 0.64,0.91). After 5 years (median of 9.9 years), bariatric surgery was associated with a lower risk of severe chronic kidney disease (HR 0.45, 95% CI 0.27,0.75), coronary disease (HR 0.49, 95% CI 0.33,0.72), diabetes (HR 0.51, 95% CI 0.47,0.56), inflammatory bowel disease (HR 0.55, 95% CI 0.37,0.83), hypertension (HR 0.70, 95% CI 0.66,0.75), chronic pulmonary disease (HR 0.75, 95% CI 0.66,0.86), asthma (HR 0.79, 95% 0.65,0.96), cancer (HR 0.79, 95% CI 0.65,0.96), and chronic heart failure (HR 0.79, 95% CI 0.64,0.96). In contrast, after 5 years, bariatric surgery was associated with an increased risk of peptic ulcer (HR 1.99, 95% CI 1.32,3.01), alcohol misuse (HR 1.55, 95% CI 1.25,1.94), frailty (HR 1.28, 95% 1.11,1.46), severe constipation (HR 1.26, 95% CI 1.07,1.49), sleep disturbance (HR 1.21, 95% CI 1.08,1.35), depression (HR 1.18, 95% CI 1.10,1.27), and chronic pain (HR 1.12, 95% CI 1.04,1.20).
Bariatric surgery was associated with lower risks of death and certain morbidities. However, bariatric surgery was also associated with increased risk of hospitalization and additional surgery, as well as certain other morbidities. Since values and preferences for these various benefits and harms may differ between individuals, this suggests that comprehensive counselling should be offered to patients considering bariatric surgery.
减重手术可使大多数接受者持续减重，并降低空腹胰岛素水平和炎症标志物。我们描述了减重手术与包括 30 种疾病在内的长期临床结果之间的关联。
我们对 304157 名患有严重肥胖症的成年人进行了回顾性基于人群的队列研究，这些成年人居住在加拿大艾伯塔省；其中 6212 人接受了减重手术。我们对手术后 5 年的死亡率、住院率、手术和 30 种新的或持续存在的疾病的调整后发病率/患病率进行了建模。
在中位随访 4.4 年（范围 1 天-22.0 年）期间，减重手术后住院（HR 1.46，95%CI 1.41，1.51）和额外手术（HR 1.42，95%CI 1.32，1.52）的风险增加，但死亡率（HR 0.76，95%CI 0.64，0.91）降低。在 5 年后（中位随访 9.9 年），减重手术后严重慢性肾病（HR 0.45，95%CI 0.27，0.75）、冠心病（HR 0.49，95%CI 0.33，0.72）、糖尿病（HR 0.51，95%CI 0.47，0.56）、炎症性肠病（HR 0.55，95%CI 0.37，0.83）、高血压（HR 0.70，95%CI 0.66，0.75）、慢性肺部疾病（HR 0.75，95%CI 0.66，0.86）、哮喘（HR 0.79，95%CI 0.65，0.96）、癌症（HR 0.79，95%CI 0.65，0.96）和慢性心力衰竭（HR 0.79，95%CI 0.64，0.96）的风险降低。相比之下，在 5 年后，减重手术后患消化性溃疡（HR 1.99，95%CI 1.32，3.01）、酒精滥用（HR 1.55，95%CI 1.25，1.94）、虚弱（HR 1.28，95%CI 1.11，1.46）、严重便秘（HR 1.26，95%CI 1.07，1.49）、睡眠障碍（HR 1.21，95%CI 1.08，1.35）、抑郁（HR 1.18，95%CI 1.10，1.27）和慢性疼痛（HR 1.12，95%CI 1.04，1.20）的风险增加。
减重手术后死亡和某些疾病的风险降低。然而，减重手术也与住院和额外手术的风险增加以及其他某些疾病有关。由于个体之间对这些各种益处和危害的价值观和偏好可能不同，因此这表明应向考虑接受减重手术的患者提供全面的咨询。
