摘要：
背景：目前关于减肥手术和死亡率有关的证据都是基于一系列对年轻妇女的研究，这些女性有较低的先天性肥胖症死亡风险。 而对老年人死亡率与减肥手术之间的联系还不太清楚。
目的：确定减肥手术与死亡率是否相关。手术对象以老年男性患者居多。
设计、设置、和参与者：Veterans Affairs医学中心对减肥手术进行了回顾性的研究。 统计了850名志愿者的死亡率，这些志愿者都在2000年1月到2006年12月做过减肥手术，他们的平均年龄为49.5岁，标准差为8.3；平均身体质量指数（BMI）为47.4，标准差为7.8。对照组的41244名志愿者都没有进行过减肥手术，他们的平均年龄为54.7，标准差为10.2；平均体重指数42.0，标准差为5.0。这些志愿者的平均观察时间为6.7年。 该研究对4个Cox比例风险模型进行了评估（包括未经调整的和调整后的基础协变量）。
主要结果测量：截止2008年12月，各种原因的死亡率。
结果：在做过减肥手术的患者中，1年、2年和6年后的死亡率大约为1.5％，2.2％和6.8％，而没有进行过手术对照组的死亡率大约为2.2％，4.6％和15.2％。 Cox回归未经调整时，减肥手术与死亡率的降低有关，风险比（HR）为0.64；95％置信区间（CI）为0.51-0.80； 协变量调整后，减肥手术仍然与死亡率的降低有关，HR为0.80；95％CI为0.63-0.995。在对1694例倾向匹配患者分析后，Cox回归未经调整时，HR为0.83；95％CI为0.61-1.14，对Cox 回归做时间调整后，HR为0.94；95％CI为0.64-1.39，减肥手术已不再与死亡率的降低有关。
结论：在倾向评分中，在对这些来自Veterans Affairs医疗中心的严重肥胖症患者的分析（基础协变量调整后）表明，在平均6.7年的观察时间内，与常规减肥相比，手术减肥和死亡率的下降并没有关系。（生物探索译）
生物探索推荐原文摘要：
Survival Among High-Risk Patients After Bariatric Surgery
Abstract
Context Existing evidence of the survival associated with bariatric surgery is based on cohort studies of predominantly younger women with a low inherent obesity-related mortality risk. The association of survival and bariatric surgery for older men is less clear.
Objective To determine whether bariatric surgery is associated with reduced mortality in a multisite cohort of predominantly older male patients who have a high baseline mortality rate.
Design, Setting, and Participants Retrospective cohort study of bariatric surgery programs in Veterans Affairs medical centers. Mortality was examined for 850 veterans who had bariatric surgery in January 2000 to December 2006 (mean age 49.5 years; SD 8.3; mean body mass index [BMI] 47.4; SD 7.8) and 41 244 nonsurgical controls (mean age 54.7 years, SD 10.2; mean BMI 42.0, SD 5.0) from the same 12 Veteran Integrated Service Networks; the mean follow-up was 6.7 years. Four Cox proportional hazards models were assessed: unadjusted and controlled for baseline covariates on unmatched and propensity-matched cohorts.
Main Outcome Measure All-cause mortality through December 2008.
Results Among patients who had bariatric surgery, the 1-, 2-, and 6-year crude mortality rates were, respectively, 1.5%, 2.2%, and 6.8% compared with 2.2%, 4.6%, and 15.2% for nonsurgical controls. In unadjusted Cox regression, bariatric surgery was associated with reduced mortality (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.51-0.80). After covariate adjustment, bariatric surgery remained associated with reduced mortality (HR, 0.80; 95% CI, 0.63-0.995). In analysis of 1694 propensity-matched patients, bariatric surgery was no longer significantly associated with reduced mortality in unadjusted (HR, 0.83; 95% CI, 0.61-1.14) and time-adjusted (HR, 0.94; 95% CI, 0.64-1.39) Cox regressions.
Conclusion In propensity score–adjusted analyses of older severely obese patients with high baseline mortality in Veterans Affairs medical centers, the use of bariatric surgery compared with usual care was not associated with decreased mortality during a mean 6.7 years of follow-up.
