Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database
Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database
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DOI：
10.1001/jamanetworkopen.2019.17603
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发表时间：
2019-12-01
影响因子：
13.8
通讯作者：
Wharam, James F.
中科院分区：
文献类型：
--
作者：
Lewis, Kristina H.;Arterburn, David E.;Wharam, James F.
重要性有几个全国性的研究比较当代肥胖programmes.OBJECTIVE比较风险的再干预后，Roux-en-Y胃旁路术（RYGB）与垂直袖状胃切除术（VSG）。设计，设置和参与者这项队列研究使用了一个全国性的美国商业保险索赔数据库。2010年1月1日至2017年6月30日期间接受首次RYGB或VSG手术的18至64岁成年人在美国地区、手术年份、最近的手术前体重指数（BMI）类别（基于诊断代码）和基线2型糖尿病方面进行匹配。预匹配池包括4496例患者接受RYGB和8627例患者接受VSG，最终加权匹配样本包括4476例患者接受RYGB和8551例患者接受VSG.EXPOSURES减肥手术程序类型（RYGB与VSG）。次要结局包括以下手术干预亚型：胆道手术、腹壁疝修补术、减肥转换或翻修术以及其他腹部手术。非手术结局包括内镜检查和肠内通路。采用多变量考克斯比例风险回归模型比较首次事件发生时间10.3岁，女性占74.1%; 13.7%的患者术前BMI在30 - 39.9之间，45.8%的患者术前BMI在40 - 49.9之间，24.2%的患者术前BMI至少为50。术后患者随访长达4年（中位数，1.6年;四分位距，0.7-3.2年），41.9%的患者至少随访2年，16.3%的患者至少随访4年。与接受RYGB的匹配患者相比，接受VSG的患者不太可能有任何后续手术干预（校正的风险比[aHR]，0.80; 95% CI，0.72-0.89），同样不太可能接受胆道手术（aHR，0.77; 95% CI，0.67-0.90），腹壁疝修补术（aHR，0.60; 95% CI，0.47-0.75），其他腹部手术（aHR，0.71; 95% CI，0.61-0.82）和内镜检查（aHR，0.54; 95% CI，0.49-0.59）或放置肠内通路（aHR，0.58; 95% CI，0.39-0.86）。接受VSG的患者更有可能接受减肥转换或修订（aHR，1.83; 95%CI，1.19-2.80）。结论和相关性在这项全国性研究中，接受VSG的患者似乎不太可能比匹配的患者接受RYGB经历随后的腹部手术干预，除了减肥转换或修订程序。考虑进行减肥手术的患者应了解RYGB与VSG相关的后续手术风险增加，这是围绕手术选择共同决策的一部分。
IMPORTANCE There are few nationwide studies comparing the risk of reintervention after contemporary bariatric procedures.OBJECTIVE To compare the risk of intervention after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG).DESIGN, SETTING, AND PARTICIPANTS This cohort study used a nationwide US commercial insurance claims database. Adults aged 18 to 64 years who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017, were matched on US region, year of surgery, most recent presurgery body mass index (BMI) category (based on diagnosis codes), and baseline type 2 diabetes. The prematch pool included 4496 patients undergoing RYGB and 8627 patients undergoing VSG, and the final weighted matched sample included 4476 patients undergoing RYGB and 8551 patients undergoing VSG.EXPOSURES Bariatric surgery procedure type (RYGB vs VSG).MAIN OUTCOMES AND MEASURES The primary outcome was any abdominal operative intervention after the index procedure. Secondary outcomes included the following subtypes of operative intervention: biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, and other abdominal operations. Nonoperative outcomes included endoscopy and enteral access. Time to first event was compared using multivariable Cox proportional hazards regression modeling.RESULTS Among 13 027 patients, the mean (SD) age was 44.4 (10.3) years, and 74.1% were female; 13.7% had a preoperative BMI between 30 and 39.9, 45.8% had a preoperative BMI between 40 and 49.9, and 24.2% had a preoperative BMI of at least 50. Patients were followed up for up to 4 years after surgery (median, 1.6 years; interquartile range, 0.7-3.2 years), with 41.9% having at least 2 years of follow-up and 16.3% having at least 4 years of follow-up. Patients undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.72-0.89) and similarly were less likely to undergo biliary procedures (aHR, 0.77; 95% CI, 0.67-0.90), abdominal wall hernia repair (aHR, 0.60; 95% CI, 0.47-0.75), other abdominal operations (aHR, 0.71; 95% CI, 0.61-0.82), and endoscopy (aHR, 0.54; 95% CI, 0.49-0.59) or have enteral access placed (aHR, 0.58; 95% CI, 0.39-0.86). Patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83; 95% CI, 1.19-2.80).CONCLUSIONS AND RELEVANCE In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures. Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB vs VSG as part of shared decision-making around procedure choice.