Association of Bariatric Surgery vs Medical Obesity Treatment With Long- term Medical Complications and Obesity- Related Comorbidities
Association of Bariatric Surgery vs Medical Obesity Treatment With Long- term Medical Complications and Obesity- Related Comorbidities
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DOI：
10.1001/jama.2017.21055
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发表时间：
2018-01-16
影响因子：
120.7
通讯作者：
Hjelmesaeth, Joran
中科院分区：
文献类型：
--
作者：
Jakobsen, Gunn Signe;Smastuen, Milada Cvancarova;Hjelmesaeth, Joran
重要性减肥手术和专门的医学肥胖治疗与有益和有害的结果之间的关联仍然不确定。目的比较接受减肥手术或专门医疗治疗的严重肥胖症患者(体重指数=40或=35，至少1例共病)中与肥胖相关的并发症的变化。设计、设置和参与者在挪威维斯特福医院信托医院的三级护理门诊中心进行了队列研究，研究对象包括2005年11月至2010年7月的暴露基线数据和2006年至死亡或2015年12月的随访数据。评估了2109名连续寻求治疗的严重肥胖症成人患者(排除221名患者，包括1888名患者)。研究对象包括减肥手术(n=932，92%的胃旁路手术)或专门的内科治疗(n=956)，包括基于个人或团体的生活方式干预计划。主要结果和衡量标准主要结果包括根据挪威处方数据库分发的药物，高血压缓解和新发高血压。预先确定的次要结果包括合并症的变化。不良事件包括从挪威患者登记处和当地实验室数据库检索的并发症。结果在纳入研究的1888名患者中，平均(SD)年龄为43.5(12.3)岁(1249名女性[66%]；平均[SD]基线体重指数为44.2[6.1]；100%完成随访，中位数为6.5年[范围，0.2-10.1])。接受手术治疗的患者高血压缓解的可能性更大，而新发高血压的可能性更小。接受手术治疗的患者糖尿病缓解的可能性也更大，新发抑郁症的风险更大，开始阿片类药物治疗的风险更大，至少再接受1次胃肠道手术的风险更大。手术组低铁蛋白水平患者的比例显著高于手术组(26%比12%，P<；.001)。结论与重度肥胖症患者平均6.5年的随访时间相关，减肥手术与内科治疗相比，在临床上具有重要意义的并发症风险增加和肥胖相关合并症风险降低。在决策过程中应考虑并发症的风险。
IMPORTANCE The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain.OBJECTIVE To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index >= 40 or >= 35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment.DESIGN, SETTING, AND PARTICIPANTS Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included).EXPOSURES Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs.MAIN OUTCOMES AND MEASURES Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database.RESULTS Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline body mass index, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of hypertension remission and lesser likelihood for new-onset hypertension. Surgically treated patients also had a greater likelihood of diabetes remission, risk of new-onset depression, treatment initiation with opioids, and greater risk of undergoing at least 1 additional gastrointestinal surgical procedure. The proportion of patients with low ferritin levels was significantly greater in the surgical group (26% vs 12%, P < .001).[GRAPHOCS].CONCLUSIONS AND RELEVANCE Among patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatmentwas associated with a clinically important increased risk for complications, aswell as lower risks of obesity-related comorbidities. The risk for complications should be considered in the decision-making process.