Kommentar zu genderspezifischen Aspekten in der Adipositas- und metabolischen Chirurgie – Daten der Qualitätssicherungsstudie für operative Therapie der Adipositas

Zusammenfassung

Hintergrund: Die aktuelle Situation der Adipositas- und metabolischen Chirurgie wird seit Januar 2005 mithilfe der Qualitätssicherungsstudie für operative Therapie der Adipositas = German Bariatric Surgery Registry (GBSR) untersucht. Die Daten werden prospektiv in Zusammenarbeit mit dem Institut für Qualitätssicherung in der operativen Medizin der Otto-von-Guericke-Universität erfasst und analysiert. Methode: Die Datenerhebung erfolgt mithilfe einer Online-Datenbank. Auf freiwilliger Grundlage werden alle Adipositas- und metabolisch-chirurgischen Eingriffe seit 2005 registriert. Zusätzlich zu den Operationsdaten werden die Befunde der jährlichen Nachsorgeuntersuchungen erhoben. Ergebnisse: Seit 2005 wurden 1263 Magenballonbehandlungen, 11 840 Sleeve-Gastrektomien, 13 722 Roux-en-Y-Gastric-Bypass- und 3999 Gastric-Banding-Operationen durchgeführt. Das mittlere Alter war bei männlichen Patienten bei allen Eingriffen signifikant höher. Der mittlere BMI war für weibliche Patienten, die ein Magenband oder einen Magenballon erhielten, signifikant geringer als bei männlichen Patienten. Männer zeigten eine höhere Inzidenz an Komorbiditäten als Frauen. Fazit: Die Zahl der Adipositas- und metabolisch chirurgischen Eingriffe steigt in Deutschland stetig an. Die Ergebnisse der Studie für operative Therapie der Adipositas (GBSR) zeigen signifikante Unterschiede für die genderspezifische Inzidenz der präoperativen Komorbiditäten, der postoperativen Komplikationen und der Mortalität. Weitere Analysen zu genderspezifischen Aspekten sind erforderlich, um die Patientenselektion zu optimieren und die postoperative Komplikationsrate zu reduzieren.

Abstract

Background: The current situation in obesity and metabolic surgery since January 2005 has been investigated with the help of the quality assurance study on surgical therapy for obesity = German Bariatric Surgery Registry (GBSR). The data were acquired and analysed in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University. Methods: Data acquisition was done with the help of an online database. On a voluntary basis, all obesity and metabolic surgical interventions since 2005 have been recorded. In addition to the surgical data, the findings of the yearly follow-up investigations were recorded. Results: Since 2005 there have been 1,263 gastric balloon procedures, 11,840 sleeve gastrectomies, 13,722 Roux-en-Y gastric bypasses and 3999 gastric banding operations. The average age of the male patients in all interventions was significantly higher. The average BMI of female patients who received a gastric banding or a gastric balloon procedure was significantly lower than that of the male patients. Men exhibited a higher incidence of comorbidities than women. Conclusion: The number of obesity and metabolic surgical interventions in Germany is continuously increasing. The results of the study on surgical therapy for obesity (GBSR) reveal significant differences in the gender-specific incidence of preoperative comorbidities. postoperative complications and mortality. Further studies on gender-specific aspects are necessary in order to optimise patient selection and reduce the incidence of postoperative complications.

• Literatur

• 1 Mensink GBM, Schienkiewitz A, Haftenberger M et al. Übergewicht und Adipositas in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DGES1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 786-794
• 2 Christou N, Sampalis JS, Liberman M et al. Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Ann Surg 2004; 240: 416-424
• 3 Stroh C, Groh C, Weiner R et al. Are there gender-specific aspects of gastric banding? Data analysis from the quality assurance study of the surgical treatment of obesity in Germany. Obes Surg 2013; 23: 1783-1789
• 4 Stroh C, Weiner R, Horbach T et al. [New data on quality assurance in bariatric surgery in Germany]. Zentralbl Chir 2013; 138: 180-188
• 5 Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23: 427-436
• 6 Stroh C, Weiner R, Wolff S et al. [Revisional surgery and reoperations in obesity and metabolic surgery: Data analysis of the German bariatric surgery registry 2005 – 2012.]. Chirurg 2014; [Epub ahead of print]
• 7 OʼBrien PE, Macdonald L, Anderson M. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 2013; 257: 87-94
• 8 Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity. Expert Rev Med Devices 2006; 3: 105-112
• 9 Stroh C, Birk D, Flade-Kuthe R et al. A nationwide survey on bariatric surgery in Germany–results 2005–2007. Obes Surg 2009; 19: 105-112
• 10 Hüttl TP, Obeidat FW, Parhofer KG et al. [Operative techniques and outcomes in metabolic surgery: sleeve gastrectomy]. Zentralbl Chir 2009; 134: 24-31
• 11 Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 2010; 252: 319-324
• 12 Weiner RA, Weiner S, Pomhoff I et al. Laparoscopic sleeve gastrectomy – influence of sleeve size and resected gastric volume. Obes Surg 2007; 17: 1297-1305
• 13 Stroh C, Köckerling F, Weiner R et al. Are there gender-specific aspects of sleeve gastrectomy-data analysis from the quality assurance study of surgical treatment of obesity in Germany. Obes Surg 2012; 22: 1214-1219
• 14 Stroh C, Weiner R, Wolff S et al. Are there gender-specific aspects in obesity and metabolic surgery? Data analysis from the German Bariatric Surgery Registry. Viszeralmedizin 2014; 30: 125-132
• 15 DeMaria EJ, Pate V, Warthen M et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2010; 6: 347-355
• 16 Stroh C, Weiner R, Wolff S et al. Influences of gender on complication rate and outcome after Roux-en-Y Gastric bypass: data analysis of more than 10,000 operations from the German Bariatric Surgery Registry. Obes Surg 2014; 24: 1625-1633
• 17 Tymitz K, Kerlakian G, Engel A et al. Gender differences in early outcomes following hand-assisted laparoscopic Roux-en-Y gastric bypass surgery: gender differences in bariatric surgery. Obes Surg 2007; 17: 1588-1591
• 18 Livingston EH, Huerta S, Arthur D et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002; 236: 576-582
• 19 Morais AA, Faintuch J, Leal AA et al. Inflammation and biochemical features of bariatric candidates: does gender matter?. Obes Surg 2011; 21: 71-77
• 20 Buchwald H, Estok R, Fahrbach K et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007; 142: 621-632
• 21 Grundmann RT, Meyer F. [Gender-specific influences on incidence, screening, treatment, and outcome of colorectal cancer]. Zentralbl Chir 2013; 138: 434-441
• 22 Grundmann RT, Meyer F. [Gender-specific influences on the results of vascular surgery]. Zentralbl Chir 2013; 138: 210-218
• 23 Carbonell AM, Lincourt AE, Matthews BD et al. National study of the effect of patient and hospital characteristics on bariatric surgery outcomes. Am Surg 2005; 71: 308-314