代谢减肥手术后酒精使用障碍和酒精相关死亡率：前瞻性对照队列研究

IF 8.8 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2025-10-03 DOI:10.1093/bjs/znaf211

Kajsa Sjöholm,Markku Peltonen,Peter Jacobson,Johanna C Andersson-Assarsson,Sofie Ahlin,Lucas Adméus,Ida Arnetorp,My Engström,Magdalena Taube,Lena M S Carlsson,Per-Arne Svensson

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引用次数: 0

摘要

背景：大量证据支持代谢性减肥手术（MBS）和酒精使用障碍（AUD）之间的联系，但可能导致酒精相关死亡率的因素仍不清楚。本研究的目的是检查MBS与AUD和酒精相关死亡风险之间的关系，最长可达35年。方法瑞典肥胖受试者（SOS）研究纳入了2007名接受MBS治疗的严重肥胖患者和2040名匹配的对照组（中位随访25.2年）。手术组患者接受胃旁路术（GBP， 266例）、胃束带术（376例）或垂直胃束带成形术（VBG， 1365例）。匹配的对照组在其初级保健中心接受严重肥胖的常规治疗。AUD诊断和酒精相关死亡率的数据分别来自瑞典国家患者登记册和瑞典死因登记册。结果在长期随访中，各手术组的AUD发生率有显著差异（log rank P < 0.001）。接受GBP的患者AUD风险最高(调整后HR (HRadj) 5.07 (95% ci . 3.11至8.25)；P < 0.001)，其次是VBG患者(HRadj 2.28 (95% ci . 1.56 ~ 3.34)；P < 0.001)和接受胃束带的患者(HRadj 2.34 (95% ci: 1.37 ~ 4.01)；P = 0.002)，与常规肥胖护理相比。GBP后酒精相关死亡率显著升高(调整后亚危险系数（sub-HRadj） 6.18 (95% ci 2.48至15.40)；P < 0.001)和VBG (hradj - 3.56 (95% ci: 1.79 ~ 7.08)；P < 0.001)。胃束带术后死亡率也升高，但未达到统计学意义(hradj - 2.52 (95% ci . 0.89 ~ 7.15)；P = 0.082)。结论：MBS患者酒精相关并发症的有效管理需要术前风险评估、术后监测和有针对性的AUD干预措施。

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Alcohol use disorder and alcohol-related mortality after metabolic bariatric surgery: prospective controlled cohort study.

BACKGROUND A body of evidence supports a link between metabolic bariatric surgery (MBS) and alcohol use disorder (AUD), while the possible contribution to alcohol-related mortality remains unclear. The aim of this study was to examine the association between MBS and the risk of AUD and alcohol-related mortality over up to 35 years. METHODS The Swedish Obese Subjects (SOS) study enrolled 2007 participants with severe obesity who underwent MBS and 2040 matched controls (median follow-up 25.2 years). Patients in the surgery group underwent gastric bypass (GBP; 266 patients), gastric banding (376 patients), or vertical banded gastroplasty (VBG; 1365 patients). The matched controls received the customary treatment for severe obesity at their primary healthcare centres. Data on AUD diagnoses and alcohol-related mortality were captured from the Swedish National Patient Register and the Swedish Cause of Death Register respectively. RESULTS During long-term follow-up, a significant difference in the incidence of AUD was found across surgery groups (log rank P < 0.001). Patients who underwent GBP exhibited the highest AUD risk (adjusted HR (HRadj) 5.07 (95% c.i. 3.11 to 8.25); P < 0.001), followed by patients who underwent VBG (HRadj 2.28 (95% c.i. 1.56 to 3.34); P < 0.001) and patients who underwent gastric banding (HRadj 2.34 (95% c.i. 1.37 to 4.01); P = 0.002), compared with usual obesity care. Alcohol-related mortality was significantly elevated after GBP (adjusted sub-HR (sub-HRadj) 6.18 (95% c.i. 2.48 to 15.40); P < 0.001) and VBG (sub-HRadj 3.56 (95% c.i. 1.79 to 7.08); P < 0.001) compared with usual obesity care. Mortality after gastric banding was also elevated, but did not reach statistical significance (sub-HRadj 2.52 (95% c.i. 0.89 to 7.15); P = 0.082). CONCLUSION Effective management of alcohol-related complications in MBS patients requires preoperative risk assessment, postoperative monitoring, and access to targeted interventions for AUD.

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.