Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients
Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients
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DOI：
10.1007/s11695-008-9428-8
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发表时间：
2007-11-01
期刊：
影响因子：
2.9
通讯作者：
Maffei, Cesare
中科院分区：
文献类型：
--
作者：
Pontiroli, Antonio E.;Fossati, Andrea;Maffei, Cesare
背景资料：减肥限制性手术的一个主要问题是临床结果的预测;非手术（依从性）和心理因素可能在减肥手术的长期结果中发挥作用。我们评估了一组短期和长期临床结果的预测因素，包括精神和心理变量，以及术后compliance.Methods的措施：172例连续患者接受腹腔镜可调节胃束带术（LAGB），至少随访12个月，进行了研究;在手术前，他们接受了NIMH诊断访谈表（版本III-R，DIS III-R）和DSM-IV轴II人格障碍的结构化临床访谈（版本2.0，SCID-II）。手术后，患者计划在前2个月内每2周进行一次访视，1年内每月一次，2年内每3个月一次;记录饮食、规则、体育锻炼的依从性，以及综合依从性（评分总和）和计划访视的出勤率。在36和48 months.Results：BMI，依从性，在预定的访问（积极），和自恋的个性（消极）出席百分比再次联系患者体重减轻在12，24（和36个月）。在48个月时也与出勤率相关。在逐步回归分析中，BMI和综合依从性预测了12个月、24个月和36个月的体重减轻，而计划访视的出勤率预测了48个月的体重减轻。自恋人格仅在12个月时预测体重减轻。结论：遵守预定就诊和遵守推荐规则，而不是人格障碍，至少在前4年内，可以预测LAGB的成功。
Background: With bariatric restrictive procedures a major issue is predictors of clinical outcome; non-surgical (compliance) and psychological factors might play a role in long term-results of bariatric surgery. We evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables, as well as measures of post-surgery compliance.Methods: 172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum of 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at 2-week intervals for the first 2 months, at monthly intervals up to 1 year and 3-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded. Patients were contacted again at 36 and at 48 months.Results: BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissistic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months). Percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months. Narcissistic personality predicted weight loss only at 12 months.Conclusion: Adherence to scheduled visits and compliance to recommended rules, more than personality disorders, predict success of LAGB, at least during the first 4 years.