未经证实:胃手术后可能发生代谢变化,据报道会导致骨质流失,骨质疏松甚至骨折。然而,关于胃手术治疗良性和恶性疾病与骨折风险之间关系的证据存在争议.这项研究的目的是评估胃手术是否与骨折的高风险相关。
UNASSIGNED:从开始到2021年10月,搜索了主要的电子数据库,以人群为基础的队列研究,调查胃手术(包括减肥胃手术和胃良性和恶性胃肿瘤的手术)与骨折风险之间的关系。使用随机效应Mantel-Haenszel模型得出具有95%置信区间(CI)的集合相对风险(RR)。进行了多个亚组分析和敏感性分析,以测试根据各种研究特征和结果的稳健性分层的异质性来源。
UNASSIGNED:共确定了14项研究,包括693134名个体进行分析。与对照组相比,接受胃手术的患者骨折风险的RR为1.45[95%置信区间(CI)1.23-1.72;I2=95.8%;P<0.001]。其中上肢骨折部位,脊柱,下肢,骨盆和髋部表现出一致的显著结果(均P<0.05),而其他骨折部位则无显著关联。对进行全胃切除术或胃大部切除术的患者也观察到显著关联(RR2.22,95%CI1.66至3.00),胃旁路术(RR1.48,95%CI1.26至1.74),并且在保留通道程序中观察到类似的趋势(包括袖状胃切除术,胃束带,垂直带状胃成形术和其他保留十二指肠和近端小肠通道的手术,与胃旁路术相反),尽管差异没有达到统计学意义(RR1.10,95%CI0.95至1.26)。观察到年龄范围为40-59岁的风险明显增加(40-49岁:RR1.36,95%CI1.19-1.55;50-59岁:RR2.48,95%CI1.58-3.90)。
未经评估:根据对基于人群的队列研究的大型汇总分析,有证据支持胃手术幸存者与对照组相比骨折风险增加.临床医生和卫生政策制定者应采取早期预防和有效干预骨折的策略。
未经授权:PROSPERO(https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=291394),标识符CRD42021291394。
UNASSIGNED: Metabolic changes may occur following gastric surgery, which has been reported to contribute to bone loss, osteoporosis and even bone fracture. However, the evidence regarding the relationship between gastric surgery for benign and malignant conditions and risk of fracture is controversial. This
study was conducted with the aim to evaluate whether gastric surgery is associated with a high risk of fracture.
UNASSIGNED: Major electronic databases were searched from inception through October 2021 for population-based cohort studies investigating the associations between gastric surgery (including bariatric gastric surgeries and surgeries for gastric benign and malignant gastric tumors) and risk of fracture compared with controls. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were derived using the random-effects Mantel-Haenszel model. Multiple subgroup analyses and sensitivity analyses were carried out to test sources of heterogeneity stratified by various
study characteristics and the robustness of the results.
UNASSIGNED: A total of 14 studies comprising 693134 individuals were identified for analysis. The RR for the risk of fracture in people undergoing gastric surgery was 1.45 [95% confidence interval (CI) 1.23 - 1.72; I2 = 95.8%; P < 0.001] compared with that in control populations, among which the fracture sites of upper limb, spine, lower limb, pelvis and hip showed consistent significant results (all P < 0.05), whereas nonsignificant associations was noted for other fracture sites. Significant associations were also observed for patients having total or subtotal gastrectomy (RR 2.22, 95% CI 1.66 to 3.00), gastric bypass (RR 1.48, 95% CI 1.26 to 1.74), and a similar trend was observed for preserved passage procedures (including sleeve gastrectomy, gastric banding, vertical banded gastroplasty and other procedures that preserved the passage through the duodenum and proximal small bowel, in contrast to gastric bypass), though the difference did not reach statistically significant (RR 1.10, 95% CI 0.95 to 1.26). An evident increased risk in the age range from 40-59 years was observed (40-49 years: RR 1.36, 95% CI 1.19-1.55; 50-59 years: RR 2.48, 95% CI 1.58-3.90).
UNASSIGNED: From this large pooled analysis of population-based cohort studies, evidence supports that fracture risk is increased in gastric surgery survivors compared with the control population. Early prevention and effective intervention strategies of bone fracture should be taken from clinicians and health policy makers.
UNASSIGNED: PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291394), identifier CRD42021291394.