番茄社区

LOS ANGELES -- Bariatric surgery went well for nearly all patients with type 2 diabetes and mild to moderate obesity, researchers said here.

In a safety study of 1,003 patients with a 30-day followup, the composite complication rate was 4.2%; 1.6% required a reoperation, and the mortality rate was 0.2% (with two deaths), said author , at the Cleveland Clinic, who presented the findings here at the . The mean surgery time was 110 minutes.

"Based on these findings, bariatric surgery can be considered a relatively safe option for managing type 2 diabetes in patients with mild obesity," said Aminian.

In an interview with 番茄社区, he noted that the reasons for the mortality rate weren't included in the data set they analyzed. But he said that one of the patients had heart disease and kidney failure, and the other, an elderly patient on insulin, was discharged without problems but died at home.

He also noted that this study was "solely a safety analysis" and that they did not examine whether type 2 diabetes was actually in remission.

Data were taken from a database provided by the American College of Surgeons National Surgical Quality Improvement Program. Nearly three-quarters of patients were female, and the average age was 53. The mean body mass index (BMI) was 33.5 and 46% had a BMI of less than 30; all patients had a BMI of ≥25 but <35 kg/m². Forty percent were using insulin, 78% had hypertension, and 9% had cardiac disease.

All participants underwent one of four surgeries: Roux-en-Y gastric bypass (574), adjustable gastric banding (227), gastric sleeve (189), and duodenal switch (13). The database also included data on more than 150 variables. All patients with evidence of preoperative sepsis, disseminated cancer, or a class 5 rating from the American Society of Anesthesiology were excluded.

An adverse event was defined as any one of 16 symptoms after surgery, including cardiovascular problems, a blood transfusion, mortality, and sepsis, among others. The two most common adverse events were blood transfusion (1.6%) and reoperation (1.6%); 0.6% had a hospital stay of longer than 7 days. Both of the deaths occurred in patients who underwent Roux-en-Y gastric bypass.

In the Roux-en-Y group, the composite morbidity and mortality was 5.0% as opposed to 3.1% in the gastric band group and 3.2% in the sleeve group. Of the 46 patients with a BMI of less than 30, only three had adverse events.

A limitation of the study is that the dataset included only short term postoperative outcomes limited to 30 days after the surgery. "However, most serious complications occur in the initial 30 days following bariatric surgery," said Aminian.

"Further large clinical studies on long-term safety and efficacy outcomes of bariatric surgery in patients with type 2 diabetes and low BMI are warranted," concluded the authors. During the session, Aminian noted that there are ongoing randomized clinical trials of a similar patient group.

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