Journal Club
Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR,
Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A,
McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ,
Thirlby R, Wolfe B.
Perioperative safety in the longitudinal assessment of bariatric surgery.
N Engl J Med. 2009 Jul 30;361(5):445-54.
Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP.
The impact of glycemic control and diabetes mellitus on perioperative
outcomes after total joint arthroplasty.
J Bone Joint Surg Am. 2009 Jul;91(7):1621-9.
2009年8月6日 8:30-8:55
8階 医局
埼玉医科大学 総合医療センター 内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田 昌文
Matsuda, Masafumi
Laparoscopic Roux en Y Gastric Bypass: LRYGB
Dr. Kasama
減量手術
245件
(内訳)
腹腔鏡下胃バイパス手
術
143件
腹腔鏡下袖状胃切除術
58件
ラップバンド手術
17件
腹腔鏡下BPD/DS
27件
Laparoscopic Gastric Banding
Before
After
その他
胃内バルーン挿入術
BIB
7件
胃バイパス術
バンディング術
減量手術全体
超過体重減少率 1)
61.60%
47.50%
61.20%
平均体重減少kg 1)
43.5kg
28.6kg
39.7kg
術死率 1)
0.50%
0.10%
術後合併症率 2)
7.90%
7.20%
再手術率 2)
1.10%
5.30%
満足しない減量の率 2)
1.00%
13.00%
糖尿病治癒率/改善率
1)
83.7% / 93.2%
47.9% / 80.8%
76.8% / 86.0%
高血圧治癒率/改善率
1)
67.5% / 87.2%
43.2% / 70.8%
61.7% / 78.5%
高脂血症改善率 1)
96.90%
58.90%
79.30%
睡眠時無呼吸改善率 1)
94.80%
68%
83.60%
1) Bariatric surgery: a systematic review and meta-analysis. Buchwald H, Avidor Y,
Braunwald E et al: JAMA. 2004 14:1724-37
2) Brazil Sao Paulo Gastro Obeso Centerでの同一スタッフによる腹腔鏡下胃バイパス術
:2012人、腹腔鏡下バンディング術1174人の検討(2005年IFSO発表)
The LABS writing group assumes responsibility for the
content of this article. Members of the LABS writing group
are listed in the Appendix. Address reprint requests to Dr.
David R. Flum at the Surgical Outcomes Research Center,
Department of Surgery, University of Washington
N Engl J Med 2009;361:445-54.
BACKGROUND
To improve decision making in
the treatment of extreme
obesity, the risks of bariatric
surgical procedures require
further characterization.
METHODS
We performed a prospective, multicenter,
observational study of 30-day outcomes in
consecutive patients undergoing bariatric
surgical procedures at 10 clinical sites in the
United States from 2005 through 2007. A
composite end point of 30-day major adverse
outcomes (including death; venous
thromboembolism; percutaneous,
endoscopic, or operative reintervention; and
failure to be discharged from the hospital)
was evaluated among patients undergoing
first-time bariatric surgery.
RESULTS
There were 4776 patients who had a first-time bariatric
procedure (mean age, 44.5 years; 21.1% men; 10.9%
nonwhite; median body-mass index [the weight in kilograms
divided by the square of the height in meters], 46.5). More
than half had at least two coexisting conditions. A Roux-en-Y
gastric bypass was performed in 3412 patients (with 87.2% of
the procedures performed laparoscopically), and
laparoscopic adjustable gastric banding was performed in
1198 patients; 166 patients underwent other procedures and
were not included in the analysis. The 30-day rate of death
among patients who underwent a Roux-en-Y gastric bypass
or laparoscopic adjustable gastric banding was 0.3%; a total
of 4.3% of patients had at least one major adverse outcome. A
history of deep-vein thrombosis or pulmonary embolus, a
diagnosis of obstructive sleep apnea, and impaired functional
status were each independently associated with an increased
risk of the composite end point. Extreme values of bodymass index were significantly associated with an increased
risk of the composite end point, whereas age, sex, race,
ethnic group, and other coexisting conditions were not.
CONCLUSIONS
The overall risk of death and other adverse
outcomes after bariatric surgery was low
and varied considerably according to
patient characteristics. In helping patients
make appropriate choices, short-term
safety should be considered in conjunction
with both the long-term effects of bariatric
surgery and the risks associated with being
extremely obese.
(ClinicalTrials.gov number, NCT00433810.)
VIEW
it is a sobering fact that some obese young
adults may lose up to 20 years of life
expectancy if they do not reduce their weight.
bariatric surgery is no more dangerous than
"having a gall bladder out, a hip replaced, or
most other major operations.
Last year, at least 220,000 obesity surgeries
were done in the US
the weight of the evidence indicates that
bariatric surgery is safe, effective, and
affordable
Message
1.肥満度の指標であるBMI(=体重kg÷身長mの2乗)
が32以上で、糖尿病またはそれ以外の2つ合併症を
もつ方(身長160cmで82kg以上)
2.BMIが37以上の方(身長160cmで95kg以上)
※ 上記の適応を満たす方で、内科的治療が効果がなか
った方
楽をしてやせるための手術ではなく、患者様の命を守るた
めの手術であることを十分に理解することです
■四谷メディカルキューブ
減量外科 笠間和典先生
http://wwwmcube.jp/
〒102-0084 東京都千代田区二番町7番7
Investigation performed at Duke University Medical
Center, Durham, North Carolina
Background
As the prevalence of diabetes mellitus in people
over the age of sixty years is expected to
increase, the number of diabetic patients who
undergo total hip and knee arthroplasty should
be expected to increase accordingly. In general,
patients with diabetes are at increased risk for
adverse events following arthroplasty. The goal
of the present study was to determine whether
the quality of preoperative glycemic control
affected the prevalence of in-hospital
perioperative complications following lower
extremity total joint arthroplasty.
METHODS
From 1988 to 2005, the Nationwide Inpatient Sample
recorded over 1 million patients who underwent joint
replacement surgery. The present retrospective study
compared patients with uncontrolled diabetes mellitus
(n = 3973), those with controlled diabetes mellitus (n =
105,485), and those without diabetes mellitus (n =
920,555) with regard to common surgical and systemic
complications, mortality, and hospital course alterations.
Additional stratification compared the effects of glucose
control among patients with Type-1 and Type-2 diabetes.
Glycemic control was determined by physician
assessments on the basis of the American Diabetes
Association guidelines with use of a combination of
patient self-monitoring of blood-glucose levels, the
hemoglobin A1c level, and related comorbidities.
RESULTS
Compared with patients with controlled diabetes mellitus, patients
with uncontrolled diabetes mellitus had a significantly increased
odds of stroke (adjusted odds ratio = 3.42; 95% confidence interval
= 1.87 to 6.25; p < 0.001), urinary tract infection (adjusted odds
ratio = 1.97; 95% confidence interval = 1.61 to 2.42; p < 0.001), ileus
(adjusted odds ratio = 2.47; 95% confidence interval = 1.67 to 3.64;
p < 0.001), postoperative hemorrhage (adjusted odds ratio = 1.99;
95% confidence interval = 1.38 to 2.87; p < 0.001), transfusion
(adjusted odds ratio = 1.19; 95% confidence interval = 1.04 to 1.36;
p = 0.011), wound infection (adjusted odds ratio = 2.28; 95%
confidence interval = 1.36 to 3.81; p = 0.002), and death (adjusted
odds ratio = 3.23; 95% confidence interval = 1.87 to 5.57; p < 0.001).
Patients with uncontrolled diabetes mellitus had a significantly
increased length of stay (almost a full day) as compared with
patients with controlled diabetes (p < 0.0001). All patients with
diabetes had significantly increased inflation-adjusted
postoperative charges when compared with nondiabetic patients
(p < 0.0001).
CONCLUSIONS
Regardless of diabetes type, patients with
uncontrolled diabetes mellitus exhibited
significantly increased odds of surgical and
systemic complications, higher mortality,
and increased length of stay during the
index hospitalization following lower
extremity total joint arthroplasty.
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