Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study.
Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study.
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DOI：
10.1056/nejmoa2002449
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发表时间：
2020-10-15
期刊：
影响因子：
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通讯作者：
Peltonen M
中科院分区：
文献类型：
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作者：
Carlsson LMS;Sjöholm K;Jacobson P;Andersson-Assarsson JC;Svensson PA;Taube M;Carlsson B;Peltonen M
肥胖会缩短预期寿命。众所周知，减肥手术可以降低长期相对死亡风险，但其对预期寿命的影响尚不清楚。我们使用 Gompertz 比例风险回归模型来比较前瞻性对照瑞典肥胖受试者 (SOS) 研究中接受减肥手术（手术组）或常规肥胖护理（对照组）的患者的死亡率和预期寿命，以及 SOS 参考研究（参考队列）（来自一般人群的随机样本）参与者的死亡率和预期寿命。总共有 2007 名患者和 2040 名患者被纳入手术组和对照组，1135 名参与者被纳入参考队列。截至分析时（2018 年 12 月 31 日），手术组死亡率中位随访时间为 24 年（四分位距，22 至 27），对照组为 22 年（四分位距，21 至 27）；研究中 99.9% 的患者可获得死亡率数据。在 SOS 参考队列中，中位随访时间为 20 年（四分位数范围为 19 至 21），并且 100% 的参与者可获得死亡率数据。手术组共有 457 名患者（22.8%）死亡，对照组有 539 名患者（26.4%）死亡（风险比为 0.77；95% 置信区间 [CI]为 0.68 至 0.87；P<0.001）。心血管疾病死亡的相应风险比为 0.70（95% CI，0.57 至 0.85），癌症死亡的相应风险比为 0.77（95% CI，0.61 至 0.96）。手术组的调整后中位预期寿命比对照组长 3.0 年（95% CI，1.8 至 4.2），但比一般人群短 5.5 年。术后90天死亡率为0.2%，手术组中有2.9%的患者接受了重复手术。在肥胖患者中，减肥手术比常规肥胖治疗的预期寿命更长。两组的死亡率仍然高于一般人群。 （由瑞典研究委员会和其他机构资助；SOS ClinicalTrials.gov 编号，NCT01479452。）
Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear. We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population. In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery. Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population. (Funded by the Swedish Research Council and others; SOS ClinicalTrials.gov number, NCT01479452.)