背景:“肥胖悖论”声称,尽管肥胖是房颤的危险因素,肥胖患者因房颤入院时的住院死亡率较低.这项研究旨在分析肥胖悖论在减肥手术减肥后是否仍然成立。方法:本研究分析了来自全国住院患者样本的出院数据,2016-2020。因心房颤动或房扑而入院的患者,有或没有肥胖,使用ICD-10-CM和ICD-10-PCS代码鉴定是否有减肥手术的既往病史.主要结果是死亡率。次要结果包括住院时间,资源利用率,气管插管的必要性,和心脏复律的必要性。STATAv.13用于单变量和多变量分析(StataCorpLLC,德州,美国)。
结果:在2,292,194名初步诊断为心房颤动或房扑的患者中,494,830人肥胖,25,940人接受了减肥手术。与普通人群相比,减重手术后患者的死亡率无显著差异(OR0.76;95%[CI0.482-1.2;p=0.24])。与普通人群相比,肥胖患者的死亡率显著降低(OR0.646;95%[CI0.583-0.717;p<0.001])。因此,与一般人群相比,减重手术后患者的死亡率高于肥胖患者.肥胖患者住院天数更多(回归0.219;95%[CI0.19-0.248,p<0.001]),具有较高的资源利用率(回归3491.995;95%[CI2870.085-4113.905,p<0.001]),更多的心脏复律(OR1.434;95%[CI1.404-1.465;p<0.001]),与普通人群相比,气管插管率无差异(OR1.02;95%[CI0.92-1.127;p=0.724])。减肥后患者的住院时间(回归-0.053;95%[CI-0.137-0.031;p=0.218])和资源利用率(回归577.297;95%[CI-1069.801-2224.396;p=0.492])没有差异,气管内插管较少(OR0.583;95%[CI0.343-0.99;p=0.046]),与普通人群相比,心脏复律更多(OR1.223;95%[CI1.134-1.32;p<0.001])。
结论:与普通人群相比,减肥后患者因心房颤动或房扑入院时的住院死亡率高于肥胖患者.这项研究加强了减肥手术后肥胖悖论在死亡率方面的存在。
BACKGROUND: The \"obesity paradox\" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for
cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA).
RESULTS: Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population.
CONCLUSIONS: Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.