Avaliação do impacto da cirurgia bariátrica na qualidade de vida de indivíduos obesos com lombalgia crônica
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2024-02-29
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Universidade Estadual Paulista (Unesp)
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Introdução: a obesidade vem aumentando em índices alarmantes no Brasil e em todo o mundo. Sabe-se que a cirurgia bariátrica é um tratamento eficaz e seguro para adultos obesos grau 2 com doenças relacionadas ou obesos grau 3. Entre as várias comorbidades associadas à essa doença, a dor lombar crônica é uma das que causam maior desconforto e perda de qualidade de vida nesses pacientes. Estudos que relacionam a o impacto da cirurgia bariátrica na vida de obesos portadores de lombalgia crônica são escassos.
Métodos: foram analisados 38 pacientes (3 homens e 35 mulheres) obesos mórbidos ou obesos grau 2, portadores de lombalgia crônica, submetidos à cirurgia bariátrica (Gastroplastia Redutora em Y de Roux e Gastrectomia Vertical, todas por videolaparoscopia). Oito variáveis foram analisadas no pré-operatório e após 6 meses de cirurgia, sendo 5 quantitativas (interleucina-6, PCR, peso, IMC e Índice Oswestry 2.0 de Incapacidade) e 3 qualitativas/categóricas (SF 36 – Capacidade Funcional, SF 36 – Limitação por Aspectos Físicos e SF 36 – Dor).
Resultados: o teste t pareado foi usado para análise estatística das variáveis quantitativas, sendo que a média dos valores de interleucina-6 no pré-operatório não foi estatisticamente diferente das dosagens no pós-operatório (p = 0,959), porém os valores de PCR (p = 0,000), peso (p = 0,000), IMC (p = 0,000) e Índice Oswestry 2.0 de Incapacidade (p = 0,000) foram todos estatisticamente diferentes.
Quanto às variáveis qualitativas, as 3 (SF 36 – Capacidade Funcional, SF 36 – Limitação por Aspectos Físicos e SF 36 – Dor) analisadas pelo teste de Wilcoxon obtiveram diferenças estatisticamente significativas.
Conclusões: Este estudo sugere que a redução substancial de peso após a cirurgia bariátrica pode estar associada a reduções importantes na lombalgia crônica no pós- operatório precoce. Este efeito pode ser o resultado de uma melhoria global no bem- estar associada à perda de peso, porém também ter como associação na redução de fatores inflamatórios, demonstrado pela queda do PCR, porém não confirmado pela IL-6. Talvez mais estudos randomizados ou não sejam necessários para a comprovação de tal efeito.
Introduction: Obesity has been increasing at alarming rates in Brazil and worldwide. It is known that bariatric surgery is an effective and safe treatment for severely obese adults with related comorbidities or morbidly obese individuals. Among the various comorbidities associated with this condition, chronic low back pain is one of the major sources of discomfort and reduced quality of life in these patients. Studies that investigate the impact of bariatric surgery on the lives of obese individuals with chronic low back pain are scarce. Methods: We analyzed 38 patients (3 males and 35 females) who were morbidly obese or severely obese grade 2 and suffered from chronic low back pain. These patients underwent bariatric surgery (Roux-en-Y gastric bypass and vertical gastrectomy, all performed laparoscopically). Eight variables were assessed before the surgery and 6 months post-surgery, comprising 5 quantitative variables (interleukin-6, C-reactive protein, weight, BMI, and Oswestry Disability Index 2.0) and 3 qualitative/categorical variables (SF-36 - Physical Functioning, SF-36 - Physical Role Limitations, and SF-36 - Pain). Results: Paired t-tests were used for the statistical analysis of quantitative variables. The mean values of interleukin-6 before the surgery did not differ statistically from post-operative measurements (p = 0.959). However, the values of C-reactive protein (p = 0.000), weight (p = 0.000), BMI (p = 0.000), and Oswestry Disability Index 2.0 (p = 0.000) were all statistically different post-operatively. As for qualitative variables, the 3 variables (SF-36 - Physical Functioning, SF-36 - Physical Role Limitations, and SF-36 - Pain) analyzed using the Wilcoxon test showed statistically significant differences. Conclusions: This study suggests that a substantial reduction in weight following bariatric surgery may be associated with significant reductions in chronic low back pain in the early post-operative period. This effect could result from an overall improvement in well-being associated with weight loss but may also be associated with a reduction in inflammatory factors, as indicated by the decrease in C-reactive protein, although not confirmed by interleukin-6. Perhaps further randomized or non- randomized studies are necessary to confirm such an effect.
Introduction: Obesity has been increasing at alarming rates in Brazil and worldwide. It is known that bariatric surgery is an effective and safe treatment for severely obese adults with related comorbidities or morbidly obese individuals. Among the various comorbidities associated with this condition, chronic low back pain is one of the major sources of discomfort and reduced quality of life in these patients. Studies that investigate the impact of bariatric surgery on the lives of obese individuals with chronic low back pain are scarce. Methods: We analyzed 38 patients (3 males and 35 females) who were morbidly obese or severely obese grade 2 and suffered from chronic low back pain. These patients underwent bariatric surgery (Roux-en-Y gastric bypass and vertical gastrectomy, all performed laparoscopically). Eight variables were assessed before the surgery and 6 months post-surgery, comprising 5 quantitative variables (interleukin-6, C-reactive protein, weight, BMI, and Oswestry Disability Index 2.0) and 3 qualitative/categorical variables (SF-36 - Physical Functioning, SF-36 - Physical Role Limitations, and SF-36 - Pain). Results: Paired t-tests were used for the statistical analysis of quantitative variables. The mean values of interleukin-6 before the surgery did not differ statistically from post-operative measurements (p = 0.959). However, the values of C-reactive protein (p = 0.000), weight (p = 0.000), BMI (p = 0.000), and Oswestry Disability Index 2.0 (p = 0.000) were all statistically different post-operatively. As for qualitative variables, the 3 variables (SF-36 - Physical Functioning, SF-36 - Physical Role Limitations, and SF-36 - Pain) analyzed using the Wilcoxon test showed statistically significant differences. Conclusions: This study suggests that a substantial reduction in weight following bariatric surgery may be associated with significant reductions in chronic low back pain in the early post-operative period. This effect could result from an overall improvement in well-being associated with weight loss but may also be associated with a reduction in inflammatory factors, as indicated by the decrease in C-reactive protein, although not confirmed by interleukin-6. Perhaps further randomized or non- randomized studies are necessary to confirm such an effect.
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Obesidade, Lombalgia, Cirrugia bariatrica, Qualidade de vida
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Gil, Bruno Ziade; Romero, Flavio Ramalho. AVALIAÇÃO DO IMPACTO DA CIRURGIA BARIÁTRICA NA QUALIDADE DE VIDA DE INDIVÍDUOS OBESOS COM LOMBALGIA CRÔNICA