The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
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DOI：
10.1001/jamasurg.2013.3654
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发表时间：
2014-03
期刊：
影响因子：
16.9
通讯作者：
Colditz, Graham A.
中科院分区：
文献类型：
--
作者：
Chang, Su-Hsin;Stoll, Carolyn R. T.;Song, Jihyun;Varela, J. Esteban;Eagon, Christopher J.;Colditz, Graham A.
肥胖症的患病率和减肥手术的结果是公认的。然而，自2003年以来，对手术影响的分析尚未更新和全面调查。最新的，全面的数据和适当的荟萃分析技术被用来检查减肥手术的有效性和风险。对Medline、Embase、Scopus、Current Contents、科克伦图书馆和Clinicaltrials.gov进行了2003年至2012年的文献检索。排除标准包括仅发表摘要、病例报告、信件、评论或综述;动物研究;英语以外的语言;重复研究;无手术干预;无关注人群。入选标准是至少报告了一项研究手术引起的关注结局-合并症、死亡率、并发症、再次手术或体重减轻。在最初识别的25，060篇文章中，24，023项研究符合排除标准，259项符合纳入标准。整个过程遵循了审查方案。三名评审员独立审查研究，提取数据，并通过共识解决分歧。对研究进行了质量评价。共纳入164项研究（37项随机对照试验（RCT）和127项观察性研究）。分析包括161，756例患者，平均年龄45岁，体重指数（BMI）46 kg/m2。我们进行了随机效应和固定效应荟萃分析和荟萃回归。在RCT中，≤30天死亡率为0.08% [95%CI，0.01%-0.24%]; >30天死亡率为0.31% [95%CI，0.01%-0.75%]。术后5年的BMI下降为12-17 kg/m2。并发症发生率为17% [95%CI，11%-23%]，再次手术率为7% [95%CI，3%-12%]。胃转流术（GB）在减肥方面更有效，但并发症更多。可调节胃束带术（AGB）的死亡率和并发症发生率较低，但再手术率较高，体重减轻程度低于GB。袖状胃切除术似乎比AGB更有效减轻体重，与GB相当。减肥手术对减肥有显著和持续的效果，并改善大多数减肥患者的肥胖相关合并症，尽管存在并发症、再次手术和死亡的风险。死亡率低于先前荟萃分析中报告的死亡率。
The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003. Up-to-date, comprehensive data and appropriate meta-analytic techniques were used to examine effectiveness and risks of bariatric surgery. Literature searches of Medline, Embase, Scopus, Current Contents, Cochrane Library, and Clinicaltrials.gov between 2003 and 2012 were performed. Exclusion criteria included publication of abstracts only, case reports, letters, comments, or reviews; animal studies; languages other than English; duplicate studies; no surgical intervention; and no population of interest. Inclusion criteria were at least one outcome of interest resulting from the studied surgery was reported – comorbidities, mortality, complications, reoperations, or weight loss. Of the 25,060 initially identified articles, 24,023 studies met the exclusion criteria, and 259 met the inclusion criteria. A review protocol was followed throughout. Three reviewers independently reviewed studies, abstracted data, and resolved disagreements by consensus. Studies were evaluated for quality. A total of 164 studies were included (37 randomized controlled trials (RCTs) and 127 observational studies). Analyses included 161,756 patients with mean age 45 years and body mass index (BMI) 46 kg/m2. We conducted random-effects and fixed-effect meta-analyses and meta-regression. In RCTs, ≤30 days mortality rate was 0.08% [95%CI, 0.01%–0.24%]; >30 days mortality rate was 0.31% [95%CI, 0.01%–0.75%]. BMI loss at the post-surgery five years was 12–17 kg/m2. The complication rate was 17% [95%CI, 11%–23%], and the reoperation rate was 7% [95%CI, 3%–12%]. Gastric bypass (GB) was more effective in weight loss but associated with more complications. Adjustable gastric banding (AGB) had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than GB. Sleeve gastrectomy appeared to be more effective in weight loss than AGB and comparable to GB. Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.
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