Rea Federico, Muraca Emanuele, Morabito Gabriella, Oltolini Alice, Bongo Alessia, Perseghin Gianluca, Corrao Giovanni, Ciardullo Stefano
University of Milano-Bicocca, Milan, Italy.
Policlinico di Monza, Monza, Italy.
Obes Surg. 2025 Jun;35(6):2240-2248. doi: 10.1007/s11695-025-07911-8. Epub 2025 May 14.
Metabolic and bariatric surgery improves most obesity-related comorbidities. Here, we evaluate the effect of different metabolic and bariatric surgery interventions on the use of medications to treat chronic conditions.
This was an observational population-based cohort study performed in Lombardy, Italy. Healthcare utilization databases were used to identify all residents who underwent a metabolic and bariatric surgery procedure between 2010 and 2020 with available follow-up data for at least three years after surgery. We included patients undergoing laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), laparoscopic adjustable gastric banding (LAGB), and biliopancreatic diversion (BPD).
During the period 2010 to 2020, 19,450 patients (22.5% males, 13.5% with diabetes) underwent a metabolic and bariatric surgery procedure. LSG was the most commonly performed procedure (65%), followed by LAGB (19%), GB (15%), and BPD (1%). There was a significant reduction in the use of glucose-lowering and antihypertensive drugs after the procedure in all groups. Compared to LSG, the reduction in the use of glucose-lowering drugs was greater following GB (reduction at 3 years: 59 vs 65%, p-interaction < 0.001) and lower following LAGB (59 vs 25%, p-interaction < 0.001). There was a significant reduction in lipid-lowering drug use following LSG and GB (3-year reduction: 21 and 50%, p-interaction < 0.001), and in psychiatric drug use following LSG, GB, and LAGB (with no difference between groups). In all groups, proton pump inhibitor use increased during the first 6 months, followed by a decrease from 1 year afterward.
The present study including a large number of patients undergoing metabolic and bariatric surgery procedures shows robust reductions in the use of glucose, blood pressure and lipid-lowering drugs at 3 years follow-up, suggesting benefits of surgery on both quality of life and healthcare costs.
代谢和减重手术可改善大多数与肥胖相关的合并症。在此，我们评估不同的代谢和减重手术干预措施对治疗慢性病药物使用的影响。
这是一项在意大利伦巴第进行的基于人群的观察性队列研究。利用医疗保健利用数据库识别出2010年至2020年间接受代谢和减重手术且术后至少有三年可用随访数据的所有居民。我们纳入了接受腹腔镜袖状胃切除术（LSG）、胃旁路术（GB）、腹腔镜可调节胃束带术（LAGB）和胆胰转流术（BPD）的患者。
在2010年至2020年期间，19450例患者（22.5%为男性，13.5%患有糖尿病）接受了代谢和减重手术。LSG是最常实施的手术（65%），其次是LAGB（19%）、GB（15%）和BPD（1%）。术后所有组中降糖药和降压药的使用均显著减少。与LSG相比，GB术后降糖药使用的减少幅度更大（3年时减少：59%对65%，交互作用p<0.001），而LAGB术后降糖药使用的减少幅度较小（59%对25%，交互作用p<0.001）。LSG和GB术后降脂药的使用显著减少（3年减少：21%和50%，交互作用p<0.001），LSG、GB和LAGB术后精神科药物的使用也显著减少（组间无差异）。在所有组中，质子泵抑制剂的使用在最初6个月增加，随后从1年后开始减少。
本研究纳入了大量接受代谢和减重手术的患者，结果显示在3年随访时降糖、降压和降脂药物的使用显著减少，表明手术对生活质量和医疗成本均有益处。
