Surgery for Obesity and Related Diseases最新文献_第10页

Association of psychiatric history with hypertension among adults who present for metabolic and bariatric surgery 接受代谢和减肥手术的成年人中精神病史与高血压的关系。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-10-11 DOI: 10.1016/j.soard.2024.10.004

Gabriel S. Tajeu Dr.P.H., M.P.H. , Jingwei Wu Ph.D. , Colleen Tewksbury Ph.D. , Jacqueline C. Spitzer M.S.Ed. , Daniel J. Rubin M.D., M.Sc , Crystal A. Gadegbeku M.D. , Rohit Soans M.D. , Kelly C. Allison Ph.D. , David B. Sarwer Ph.D.

Background

Psychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m²) and may be associated with hypertension.

Objectives

To determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS).

Setting

Academic medical center.

Methods

Outcomes were identified from electronic medical records. Psychiatric diagnoses were assessed by clinical interview and included any bipolar and related disorder or depressive disorders, anxiety, alcohol use disorder, substance use disorder, post-traumatic stress disorder, and eating disorders. Adjusted odds ratios for the association between psychiatric diagnoses and hypertension and uncontrolled BP, separately, were calculated using logistic regression. Linear regression was used to determine the association of psychiatric diagnoses with SBP. Models were adjusted for age, sex, race, and BMI.

Results

There were 281 participants with mean age of 40.5 years (standard deviation = 10.9) and BMI of 45.9 kg/m² (standard deviation = 6.2). Participants were predominantly women (86.5%) and Black (57.2%). Overall, 44.8% had hypertension and 32.5% of these individuals had uncontrolled BP. The adjusted odds ratios for hypertension was higher (2.95; 95% confidence interval 1.48–5.87) and SBP was greater (3.50 mm Hg; P = .048) among participants with a lifetime diagnosis of anxiety compared with those without. Participants with any current psychiatric diagnosis had a higher SBP compared to those who did not have a current psychiatric diagnosis (3.62 mm Hg; P = .029).

Conclusions

A diagnosis of anxiety during the lifetime of patients undergoing MBS was associated with almost three times increased odds of hypertension.

背景：在重度肥胖（体重指数[BMI]≥40 kg/m2）的成年人中，精神病诊断很常见，而且可能与高血压有关：目的：在接受代谢和减肥手术（MBS）的重度肥胖成人中，确定终生和当前精神病诊断分别与高血压、未控制血压（BP）和收缩压（SBP）之间的关联：地点：学术医疗中心：方法：从电子病历中确定结果。精神病诊断通过临床访谈进行评估，包括任何躁郁症及相关障碍或抑郁症、焦虑症、酒精使用障碍、药物使用障碍、创伤后应激障碍和进食障碍。使用逻辑回归法分别计算了精神科诊断与高血压和血压失控之间的调整几率比。线性回归用于确定精神科诊断与 SBP 的关系。模型根据年龄、性别、种族和体重指数进行了调整：281 名参与者的平均年龄为 40.5 岁（标准差 = 10.9），体重指数为 45.9 kg/m2（标准差 = 6.2）。参与者主要为女性（86.5%）和黑人（57.2%）。总体而言，44.8%的人患有高血压，其中 32.5%的人血压未得到控制。与未被诊断出焦虑症的参与者相比，终生被诊断出焦虑症的参与者患高血压的调整后几率更高（2.95；95% 置信区间 1.48-5.87），SBP更高（3.50 mm Hg；P = .048）。与目前没有精神病诊断的人相比，目前有任何精神病诊断的参与者的 SBP 较高（3.62 毫米汞柱；P = .029）：结论：接受 MBS 治疗的患者在一生中被诊断出患有焦虑症，其患高血压的几率几乎增加了三倍。

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引用次数: 0

National trends in using revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: a matched case-control analysis 袖带胃切除术后因反流和体重复发而使用翻修手术的全国趋势：匹配病例对照分析。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-10-09 DOI: 10.1016/j.soard.2024.09.011

Thomas H. Shin M.D., Ph.D. , Pourya Medhati M.D. , Vasundhara Mathur M.D. , Abdelrahman Nimeri M.D. , Eric G. Sheu M.D., Ph.D. , Ali Tavakkoli M.D.

Background

Several options exist for surgical conversion after sleeve gastrectomy (SG), but a definitive safety profile for each option by indication for conversion remains unclear.

Objectives

To determine and compare 30-day risk profiles of SG conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy (SADI).

Methods

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database entries from 2020 to 2022 were used to identify 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI. Subgroup analyses were performed among 6106 conversions completed for weight-related complications (RYGB: 3053 patients; BPD-DS: 1826 patients; SADI: 1227 patients). Multivariable analysis and 1:1 nearest-neighbor matching were used to further characterize the 30-day risk profile of each conversion.

Results

Patients with RYGB conversions had a lower preoperative body mass index compared with those with BPD-DS + SADI conversions (39.8 versus 46.1, P < .001) and significantly lower rates of medical comorbidities. The distribution of conversion indication for each MBS configuration varied, where most RYGB conversions were for reflux (56.1%) whereas most BPD-DS + SADI conversions were for weight-related complications (87.3%; P < .001). On 1:1 matched analysis of conversions for weight recurrence, odds of 30-day complications (odds ratio .73, P = .019) and readmission (odds ratio .77, P = .031) were lower in BPD-DS + SADI conversions compared with RYGB. There were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS + SADI. Major differing drivers of complications between conversion types included hemorrhage (RYGB 1.98% versus BPD-DS + SADI .87%; P = .001).

Conclusions

For weight recurrence after SG, conversion to BPD-DS + SADI does not have greater 30-day complications than RYGB and may be a safe conversion option.

背景：袖带胃切除术（SG）后有几种手术转流方案，但根据转流适应症确定每种方案的安全性仍不明确：目的：确定并比较袖带胃切除术后转为Roux-en-Y胃旁路术（RYGB）、胆胰转流十二指肠手术（BPD-DS）和单吻合十二指肠造口术（SADI）的30天风险概况：利用代谢与减肥手术认证和质量改进计划 2020 年至 2022 年的国家数据库条目，确定了 25760 名接受 SG 转换为 RYGB、BPD-DS 或 SADI 的成年患者。在 6106 名因体重相关并发症而完成转换的患者中进行了分组分析（RYGB：3053 名患者；BPD-DS：1826 名患者；SADI：1227 名患者）。采用多变量分析和1:1近邻匹配来进一步确定每种转归的30天风险特征：结果：与 BPD-DS + SADI 转换患者相比，RYGB 转换患者的术前体重指数较低（39.8 对 46.1，P < .001），合并症发生率明显较低。每种 MBS 配置的转换适应症分布各不相同，其中大多数 RYGB 转换适应症是由于反流（56.1%），而大多数 BPD-DS + SADI 转换适应症是由于体重相关并发症（87.3%；P < .001）。对因体重复发而转为 BPD-DS + SADI 的患者进行 1:1 匹配分析后发现，与 RYGB 相比，BPD-DS + SADI 患者的 30 天并发症几率（几率比 0.73，P = 0.019）和再入院几率（几率比 0.77，P = 0.031）更低。转为 RYGB 和 BPD-DS + SADI 的患者 30 天内再次干预或再次手术的几率没有明显差异。不同转换类型并发症的主要驱动因素包括出血（RYGB为1.98%，BPD-DS + SADI为0.87%；P = .001）：结论：对于 SG 后体重复发的患者，转用 BPD-DS + SADI 的 30 天并发症并不比 RYGB 多，可能是一种安全的转用选择。

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引用次数: 0

Subjective improvement of reflux symptoms after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass and concomitant repair of hiatal hernia 袖带胃切除术转为 Roux-en-Y 胃旁路术并同时修复食管裂孔疝后反流症状的主观改善。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-10-09 DOI: 10.1016/j.soard.2024.09.014

Luke Umana M.D., Jenalee Corsello M.D., Thomas Grist B.S., John Paul Gonzalvo D.O., John Dietrick M.D., Michel M. Murr M.D.

Background

Symptoms of reflux after sleeve gastrectomy (SG) are common and may be refractory to medical treatment.

Objectives

To assess outcomes of conversion of SG to Roux-en-Y gastric bypass (RYGB) with concomitant repair of hiatal hernias on symptoms of reflux.

Setting

Tertiary community hospital.

Methods

We reviewed data from all consecutive patients (2018–2021) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and postoperative proton pump inhibitor (PPI) use were compared with McNemar statistical test. Data are reported as mean ± standard deviation.

Results

In total, 64 patients (92% female; 48 ± 10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4 ± 3 years after the index SG. A hiatal hernia was detected preoperatively in 57 of 64 patients (89%) by either upper gastrointestinal contrast studies, computed tomography scan, or esophagogastroduodenoscopy. At 29 ± 14 months postconversion to RYGB, percent total body weight loss was 14 ± 9% and percent excess weight loss was 37 ± 29%, and body mass index decreased from 37 ± 7 to 32 ± 6 kg/m². Symptoms of reflux and use of PPI improved during the early follow-up period (median: 14 months; P < .001) and was sustained at late follow-up (median: 32 months; P < .01). Improvement of nausea and dysphagia reached statistical significance at late follow-up (median: 32 months; P < .01). Vomiting and abdominal pain decreased with time but did not reach statistical significance. Postoperative complications were deep surgical-site infection (n = 3), pulmonary embolism (n = 1), bleeding (n = 5), reoperation (n = 3), and 30-day readmission (n = 6).

Conclusions

Conversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.

背景：袖带胃切除术（SG）后出现反流症状很常见，而且可能是药物治疗的难治性症状：目的：评估袖带胃切除术后转为 Roux-en-Y 胃旁路术（RYGB）并同时进行裂孔疝修补术对反流症状的影响：地点：三级社区医院：我们回顾了所有因难治性反流症状而从 SG 转为 RYGB 的连续患者（2018-2021 年）的数据。并发食管裂孔疝经内镜或放射学检查确诊。反流症状、恶心、呕吐、吞咽困难或腹痛的改善情况以及术后质子泵抑制剂（PPI）的使用情况通过 McNemar 统计检验进行比较。数据以均数±标准差表示：共有 64 名患者（92% 为女性；48 ± 10 岁）在接受 SG 手术 4 ± 3 年后，从 SG 转为 RYGB 并修补了同时存在的食管裂孔疝。64 名患者中有 57 人（89%）在术前通过上消化道造影、计算机断层扫描或食管胃十二指肠镜检查发现了食管裂孔疝。在转为 RYGB 后的 29±14 个月中，总体重减轻百分比为 14±9% ，超重百分比为 37±29% ，体重指数从 37±7 kg/m2 降至 32±6 kg/m2。反流症状和使用 PPI 的情况在早期随访期间有所改善（中位数：14 个月；P < .001），并在后期随访期间持续改善（中位数：32 个月；P < .01）。恶心和吞咽困难的改善在后期随访中达到统计学意义（中位数：32 个月；P < .01）。随着时间的推移，呕吐和腹痛有所减轻，但未达到统计学意义。术后并发症为手术部位深部感染（3例）、肺栓塞（1例）、出血（5例）、再次手术（3例）和30天再次入院（6例）：结论：将 SG 转为 RYGB 并修复同时存在的食管裂孔疝可改善反流症状、恶心和吞咽困难，减少 PPI 的使用，并减轻体重。

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引用次数: 0

Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis 单吻合胃旁路术与 Roux-en-Y 胃旁路术术后 5 年的效果比较：倾向分数匹配分析。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-10-05 DOI: 10.1016/j.soard.2024.09.009

Lindsy van der Laan M.D. , Dionne Sizoo M.Sc., Ph.D. , André P. van Beek M.D., Ph.D. , Marloes Emous M.D., Ph.D.

Background

Previous studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations.

Objectives

This study aims to compare OAGB and RYGB during 5 years of follow-up in terms of weight loss, remission of comorbidities, and complications.

Setting

This longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity.

Methods

A 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB.

Results

After 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; P = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; P < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5 years (30.0% after OAGB and 28.8% after RYGB; P = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (P = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; P = .015).

Conclusions

OAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.

背景：以往比较单吻合口胃旁路术（OAGB）和Roux-en-Y胃旁路术（RYGB）的研究通常受限于回顾性设计，或在随机对照试验中受限于样本量小或随访时间有限：本研究旨在比较 OAGB 和 RYGB 在 5 年随访期间的体重减轻、合并症缓解和并发症情况：这项纵向前瞻性研究包括 2015 年至 2016 年期间在荷兰接受初治 OAGB 或 RYGB 的所有患者，利用的数据来自全国范围的肥胖症治疗登记--荷兰肥胖症治疗审计：对OAGB和RYGB患者进行1:1倾向得分匹配（PSM）比较：结果：经过 1:1 PSM 比对后，获得了两个几乎相同的队列，共 860 名患者。OAGB 与更多的术中并发症相关（2.0% 对 .6%；P = .031）。相反，RYGB 的短期并发症发生率更高（7.6% 对 3.8%；P < .001）。有 40.7% 的 OAGB 患者和 34.9% 的 RYGB 患者提供了五年的数据。5 年后总重量下降的百分比无明显差异（OAGB 后为 30.0%，RYGB 后为 28.8%；P = .099）。OAGB 和 RYGB 的糖尿病总缓解率分别为 60.5%和 69.4%（P = .656）。然而，与 RYGB 相比，OAGB 的高血压缓解率明显更高（60.2% 对 45.5%；P = .015）：结论：OAGB 和 RYGB 的减肥效果相当。结论：OAGB 和 RYGB 的减肥效果相当，但 OAGB 的术中并发症较多，而 RYGB 的短期并发症较多。两种手术对糖尿病缓解的疗效相似，但 OAGB 对高血压缓解的疗效更好。

{"title":"Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis","authors":"Lindsy van der Laan M.D. , Dionne Sizoo M.Sc., Ph.D. , André P. van Beek M.D., Ph.D. , Marloes Emous M.D., Ph.D.","doi":"10.1016/j.soard.2024.09.009","DOIUrl":"10.1016/j.soard.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations.</div></div><div><h3>Objectives</h3><div>This study aims to compare OAGB and RYGB during 5years of follow-up in terms of weight loss, remission of comorbidities, and complications.</div></div><div><h3>Setting</h3><div>This longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity.</div></div><div><h3>Methods</h3><div>A 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB.</div></div><div><h3>Results</h3><div>After 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; <em>P</em> = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; <em>P</em> < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5years (30.0% after OAGB and 28.8% after RYGB; <em>P</em> = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (<em>P</em> = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>OAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 263-270"},"PeriodicalIF":3.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of Obesity-related Metabolic Conditions: a novel objective scoring system better informs metabolic disease severity 肥胖相关代谢疾病评估：一种新型客观评分系统能更好地反映代谢疾病的严重程度。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-09-19 DOI: 10.1016/j.soard.2024.09.004

Victoria Lyo M.D., M.T.M. , John Arriola M.D. , Shushmita M. Ahmed M.D. , Rouzbeh Mostaedi M.D. , Zainab Akinjobi M.Sc. , Hazem N. Shamseddeen M.D. , Mohamed R. Ali M.D.

Background

Reporting of obesity-associated metabolic disease severity and longitudinal response to bariatric surgery is not standardized. We updated our co-morbidity scoring tool to the Assessment of Obesity-related Metabolic Conditions (AOMC) to combine pharmacotherapy and biochemical data to score diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS) severity.

Objectives

The aim of this study is to determine whether the AOMC system more accurately stages metabolic disease severity than a clinically based Assessment of Obesity-Related Comorbidities (AORC) system.

Setting

University hospital, United States.

Methods

A retrospective cohort study of prospectively collected demographic, clinical, and biochemical data was performed on adults evaluated for bariatric surgery over 6 years. AORC versus AOMC scores and disease severity were compared using McNemar’s and Wilcoxon’s tests.

Results

Of 1442 patients, AOMC newly diagnosed metabolic disease in more patients than did AORC: DM (73.4% versus 44.5%), HTN (91.7% versus 67.9%), and DYS (63.8% versus 53.4%). Of those on pharmacotherapy, AOMC found fewer patients with adequately controlled disease: DM (39.9% versus 97.7%), HTN (64.7% versus 99.3%), and DYS (51.8% versus 99.0%). For those in whom both scores could be calculated, disease severity was upstaged in most patients: DM (65.9%), HTN (42.9%), and DYS (30.9%). There were also significant shifts toward higher scores for all conditions and severity classifications, with more patients diagnosed with pre–metabolic and severe disease (untreated/uncontrolled).

Conclusions

Our study demonstrated that the severity of DM, HTN, and DYS is vastly under-represented by clinical history alone and lacks standardized assessments. Our AOMC tool more accurately describes longitudinal metabolic response to bariatric surgery.

背景：肥胖相关代谢疾病严重程度和减肥手术纵向反应的报告尚未标准化。我们将合并疾病评分工具更新为肥胖相关代谢疾病评估（AOMC），结合药物治疗和生化数据对糖尿病（DM）、高血压（HTN）和血脂异常（DYS）的严重程度进行评分：本研究旨在确定 AOMC 系统是否比基于临床的肥胖相关并发症评估系统（AORC）更准确地分级代谢疾病的严重程度：地点：美国大学医院：方法：对前瞻性收集的人口、临床和生化数据进行回顾性队列研究，研究对象为接受减肥手术评估的成年人，时间跨度为 6 年。采用麦克尼马检验和威尔科克森检验比较了AORC和AOMC评分以及疾病严重程度：在1442名患者中，AOMC比AORC新诊断出更多代谢性疾病：糖尿病（73.4%对44.5%）、高血压（91.7%对67.9%）和DYS（63.8%对53.4%）。在接受药物治疗的患者中，AOMC发现病情得到充分控制的患者较少：DM（39.9%对97.7%）、HTN（64.7%对99.3%）和DYS（51.8%对99.0%）。在可以计算出这两项评分的患者中，大多数患者的疾病严重程度都有所升高：DM（65.9%）、HTN（42.9%）和 DYS（30.9%）。所有疾病和严重程度分类的得分也明显偏高，更多患者被诊断为代谢前疾病和严重疾病（未治疗/未控制）：我们的研究表明，仅凭临床病史对糖尿病、高血压和慢性肾脏病严重程度的了解远远不够，而且缺乏标准化的评估。我们的AOMC工具能更准确地描述减肥手术的纵向代谢反应。

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引用次数: 0

SOARD Category 1 CME Credit Featured Articles, Volume 20, October 2024 SOARD 第 1 类 CME 学分精选文章，第 20 卷，2024 年 10 月

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-09-09 DOI: 10.1016/j.soard.2024.08.027

引用次数: 0

Cartoon 卡通

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-09-09 DOI: 10.1016/j.soard.2024.08.028

引用次数: 0

SOARD Category 1 CME Credit Featured Articles, Volume 20, September 2024 SOARD 第 1 类 CME 学分精选文章，第 20 卷，2024 年 9 月

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-08-27 DOI: 10.1016/j.soard.2024.08.023

引用次数: 0

Cartoon 卡通

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-08-27 DOI: 10.1016/j.soard.2024.08.024

引用次数: 0

Predicting serious postoperative complications and evaluating racial fairness in machine learning algorithms for metabolic and bariatric surgery 预测术后严重并发症，评估代谢和减肥手术机器学习算法的种族公平性。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2024-08-13 DOI: 10.1016/j.soard.2024.08.008

Dong-Won Kang Ph.D. , Shouhao Zhou Ph.D. , Russell Torres Ph.D. , Abhinandan Chowdhury Ph.D. , Suman Niranjan Ph.D. , Ann Rogers M.D. , Chan Shen Ph.D.

Background

Predicting the risk of complications is critical in metabolic and bariatric surgery (MBS).

Objectives

To develop machine learning (ML) models to predict serious postoperative complications of MBS and evaluate racial fairness of the models.

Setting

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database, United States.

Methods

We developed logistic regression, random forest (RF), gradient-boosted tree (GBT), and XGBoost model using the MBSAQIP Participant Use Data File from 2016 to 2020. To address the class imbalance, we randomly undersampled the complication-negative class to match the complication-positive class. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. Fairness across White and non-White patient groups was assessed using equal opportunity difference and disparate impact metrics.

Results

A total of 40,858 patients were included after undersampling the complication-negative class. The XGBoost model was the best-performing model in terms of AUROC; however, the difference was not statistically significant. While the F1 score and precision did not vary significantly across models, the RF exhibited better recall compared to the logistic regression. Surgery type was the most important feature to predict complications, followed by operative time. The logistic regression model had the best fairness metrics for race.

Conclusions

The XGBoost model achieved the highest AUROC, albeit without a statistically significant difference. The RF may be useful when recall is the primary concern. Undersampling of the privileged group may improve the fairness of boosted tree models.

背景：在代谢和减肥手术（MBS）中，预测并发症的风险至关重要：预测并发症风险对于代谢和减肥手术（MBS）至关重要：开发机器学习（ML）模型来预测代谢与减肥手术术后严重并发症，并评估模型的种族公平性：方法：我们开发了逻辑回归、随机聚类分析和 "MBS "模型，以预测MBS术后严重并发症：我们使用2016年至2020年的MBSAQIP参与者使用数据文件开发了逻辑回归、随机森林（RF）、梯度增强树（GBT）和XGBoost模型。为了解决类别不平衡的问题，我们随机对并发症阴性类别进行低采样，以匹配并发症阳性类别。模型性能使用接收者操作特征曲线下面积（AUROC）、精确度、召回率和 F1 分数进行评估。使用机会均等差异和差异影响指标对白人和非白人患者群体的公平性进行了评估：结果：在对并发症阴性患者进行低采样后，共纳入了 40858 名患者。就 AUROC 而言，XGBoost 模型是表现最好的模型，但差异在统计学上并不显著。虽然不同模型的 F1 得分和精确度差异不大，但 RF 与逻辑回归相比具有更好的召回率。手术类型是预测并发症的最重要特征，其次是手术时间。逻辑回归模型的种族公平性指标最好：XGBoost模型获得了最高的AUROC，尽管在统计学上没有显著差异。当召回率是主要考虑因素时，RF 可能会有用。对特权组进行低采样可能会提高提升树模型的公平性。

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引用次数: 0