建立不同職業肥胖患者減重手術治療成效之預測模型

Objective: Obesity prevalence in developed and developing countries around the world has reached epidemic proportions. Risk factors of obesity includes social determinants related to occupations, such as the working environment and the characteristics of occupation. The effectiveness of bariatric surgery for patients from different occupations has not been explored in the previous studies. This article analyzes patients in different occupational backgrounds, including factors that may predict postoperative outcomes: different occupational categories, different occupational labor levels, preoperative body compositions and biochemical markers. We aim to establish a model for predicting the effectiveness of bariatric surgery. Design: This study is a retrospective case-control study. We enrolled 101 patients with morbid obesity undergoing laparoscopic sleeve gastrectomy and followed for one year. The percentage of excess weight loss (%EWL) after one year of surgery is used as an indicator of the success of bariatric surgery. We analyze factors that may affect the outcome of the surgery including occupational categories (six items), occupational labor levels (three items), preoperative body compositions and biochemical markers. The occupational categories include six groups, and the occupational labor levels include three groups according to the different degrees of labor hardship, which are divided into mild, moderate, and severe. First, we use the Mann-Whitney U test and the Chi-square test to perform nonparametric analysis, find independent variables, and further use the multivariate logistic regression to predict the factors of effectiveness of bariatric surgery. Then we calculate the area under the ROC curve to determine the correctness of the prediction. Setting: One hospital, Taipei Medical University Hospital(TMUH). Patients: Patients with morbid obesity who underwent bariatric surgery in TMUH were included. Intervention: Bariatric surgery. Measurements and Main Results: Nonparametric analysis shows that there is no statistically significant difference between the occupational labor levels and the success rate of one-year bariatric surgery (p=0.165), but significantly difference between the occupational categories and the success rate of one-year bariatric surgery is noted (p=0.009). Among factors of preoperative body compositions and biochemical markers, there is significant differences in hip circumference (p=0.008), fat mass (p=0.001), and body mass index (BMI) (p=0.004) (Table 1). Then we use the multivariate logistic regression to model these significant factors by backward selection, the result shows that only the preoperative BMI has a statistically significant difference (p=0.026, OR=0.817). The ROC curve of BMI shows that the area under the curve is 0.73. (Figure 1). Conclusions:Bariatric surgery is indeed one of the most effective weight loss methods to treat morbid obesity. Different occupations and occupational labor levels will not affect the first year success rate of bariatric surgery. The preoperative BMI is the only predictor of the first year success rate of bariatric surgery.