OBJECTIVE This study assessed all-cause and specific-cause mortality after Roux-en-Y gastric bypass (RYGB) and in matched control subjects, stratified by diabetes status.

RESEARCH DESIGN AND METHODS RYGB patients were matched by age, BMI, sex, and diabetes status at time of surgery to nonsurgical control subjects using data from the electronic health record. Kaplan-Meier curves and Cox regression were used to assess differences in all-cause and specific-cause mortality between RYGB patients and control subjects with and without diabetes.

RESULTS Of the 3,242 eligible RYGB patients enrolled from January 2004 to December 2015, control subjects were identified for 2,428 (n = 625 with diabetes and n = 1,803 without diabetes). Median postoperative follow-up was 5.8 years for patients with diabetes and 6.7 years for patients without diabetes. All-cause mortality was reduced in RYGB patients compared with control subjects only for those with diabetes at the time of surgery (adjusted hazard ratio = 0.44; P < 0.0001). Mortality was not significantly improved in RYGB patients without diabetes compared with control subjects without diabetes (adjusted hazard ratio 0.84; P = 0.37). Deaths from cardiovascular diseases (P = 0.011), respiratory conditions (P = 0.017), and diabetes P = 0.011) were more frequent in control subjects with diabetes than in RYGB patients with diabetes. RYGB patients without diabetes were less likely to die of cancer (P = 0.0038) and respiratory diseases (P = 0.046) than control subjects without diabetes, but were at higher risk of death from external causes (P = 0.012), including intentional self-harm (P = 0.025) than control subjects without diabetes.

CONCLUSIONS All-cause mortality benefits of RYGB are driven predominantly by patients with diabetes at the time of surgery. RYGB patients with diabetes were less likely to die of cardiovascular diseases, diabetes, and respiratory conditions than their counterparts without RYGB.

目的本研究评估了Roux-en-Y胃搭桥术（RYGB）后以及在匹配的对照受试者中按糖尿病状态分层的全因和特定原因死亡率。

研究设计和方法使用电子健康记录中的数据，将RYGB患者按手术时的年龄，BMI，性别和糖尿病状况与非手术对照组进行匹配。Kaplan-Meier曲线和Cox回归用于评估RYGB患者与有无糖尿病的对照组之间全因和特定因死亡率的差异。

结果从2004年1月至2015年12月登记的3,242例合格RYGB患者中，确定了2,428例为对照受试者（n = 625例糖尿病，n = 1,803例无糖尿病）。糖尿病患者的中位术后随访时间为5.8年，非糖尿病患者的中位随访时间为6.7年。RYGB患者的全因死亡率与仅在手术时患有糖尿病的对照受试者相比有所降低（调整后的危险比= 0.44；P <0.0001）。与没有糖尿病的对照组相比，没有糖尿病的RYGB患者的死亡率没有显着改善（风险比调整为0.84；P = 0.37）。心血管疾病死亡（P与RYGB糖尿病患者相比，糖尿病对照组的呼吸频率（P = 0.011），呼吸系统疾病（P = 0.017）和糖尿病P = 0.011）更为频繁。与没有糖尿病的对照组相比，没有糖尿病的RYGB患者死于癌症（P = 0.0038）和呼吸系统疾病（P = 0.046）的可能性更小，但因外部原因而死亡的风险更高（P = 0.012），包括有意自我干预。伤害（P = 0.025）高于没有糖尿病的对照对象。

结论RYGB的全因死亡率益处主要由手术时的糖尿病患者决定。与没有RYGB的患者相比，患有糖尿病的RYGB患者死于心血管疾病，糖尿病和呼吸系统疾病的可能性更低。