Information de reference pour ce titreAccession Number: | 01714645-201412000-00015.
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Author: | Arterburn, David MD, MPH 1; Powers, David J. MS 2; Toh, Sengwee ScD 3; Polsky, Sarit MD, MPH 4; Butler, Melissa G. PharmD, MPH 5; Portz, Dickman J. PhD 2; Donahoo, William T. MD 4,6; Herrinton, Lisa PhD 7; Williams, Rebecca J. DrPH, MPH 8; Vijayadeva, V. PhD, MBBS, MPH 9; Fisher, David MD 10; Bayliss, Elizabeth A. MD, MSPH 2
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Institution: | (1)Group Health Research Institute, Seattle, Washington (2)Kaiser Permanente Colorado Institute for Health Research, Denver (3)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (4)University of Colorado School of Medicine, Aurora (5)Kaiser Permanente Georgia Center for Health Research Southeast, Atlanta (6)Colorado Permanente Medical Group, Aurora (7)Kaiser Permanente Division of Research, Oakland, California (8)University of Hawai'i at Manoa, Honolulu (9)Kaiser Permanente Hawaii Center for Health Research, Honolulu (10)Kaiser Permanente, Oakland, California
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Title: | |
Source: | JAMA Surgery. 149(12):1279-1287, December 2014.
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Abstract: | IMPORTANCE: Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures.
OBJECTIVE: To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States.
MAIN OUTCOMES AND MEASURES: The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention.
RESULTS: We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score-adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively.
CONCLUSIONS AND RELEVANCE: In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.
Copyright 2014 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.
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Language: | English.
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Document Type: | Research: Original Investigation: Online First.
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ISSN: | 2168-6254
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DOI Number: | https://dx.doi.org/10.1001/jamas...- ouverture dans une nouvelle fenêtre
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