Livingston Edward H, Huerta Sergio, Arthur Denice, Lee Scott, De Shields Scott, Heber David
VAMC Greater Los Angeles Health Care System, the UCLA Bariatric Surgery Program, and the UCLA Center for Human Nutrition, Los Angeles, California 90095-6904, USA.
Ann Surg. 2002 Nov;236(5):576-82. doi: 10.1097/00000658-200211000-00007.
To determine preoperative risk factors predictive of adverse outcomes after gastric bypass surgery.
Gastric bypass results in sustained weight loss for seriously obese patients, but perioperative complications can be formidable. Preoperative risk assessment is important to establish the risk-benefit ratio for patients undergoing these operations.
Data for 10 risk factors predictive of adverse outcomes were collected on 1,067 consecutive patients undergoing gastric bypass surgery at the UCLA Medical Center from December 1993 until June 2000. Univariate analyses were performed for individual risk factors to determine their potential significance as predictors for complications. All 10 risk factors were entered into a logistic regression model to determine their significance as predictors for complications. Sensitivity analysis was performed.
Univariate analysis revealed that male gender and weight were predictive of severe life-threatening adverse outcomes. Multistep logistic regression yielded only male gender as a risk factor. Male patients were heavier than female patients on entry to the study, accounting for weight as a potential risk factor. Patients older than 55 years had a threefold higher mortality from surgery than younger patients, although the complication rate, 5.8%, was the same in both groups. Sensitivity analysis demonstrated that the risk for severe life-threatening adverse outcomes in women increased from 4% for a 200-lb female patient to 7.5% for a 600-lb patient. The risk increased from 7% for a 200-lb male patient to 13% for a 600-lb patient.
Large male patients are at greater risk for severe life-threatening complications than smaller and/or female patients. Risk factors thought to be predictive of adverse outcomes, such as a history of smoking or diabetes, proved not to be significant in this analysis. Older patients had the same complication rate but a threefold higher mortality, suggesting that they lack the reserve to recover from complications when they occur.
确定胃旁路手术后不良结局的术前预测风险因素。
胃旁路手术可使严重肥胖患者持续减重，但围手术期并发症可能很严重。术前风险评估对于确定接受这些手术患者的风险效益比很重要。
收集了1993年12月至2000年6月在加州大学洛杉矶分校医学中心连续接受胃旁路手术的1067例患者的10项不良结局预测风险因素数据。对各个风险因素进行单因素分析，以确定其作为并发症预测指标的潜在意义。将所有10项风险因素纳入逻辑回归模型，以确定其作为并发症预测指标的意义。进行了敏感性分析。
单因素分析显示，男性和体重可预测严重危及生命的不良结局。多步逻辑回归仅得出男性为风险因素。男性患者在进入研究时比女性患者体重更重，这使得体重成为一个潜在风险因素。55岁以上患者手术死亡率比年轻患者高三倍，尽管两组并发症发生率均为5.8%。敏感性分析表明，女性严重危及生命的不良结局风险从200磅女性患者的4%增加到600磅患者的7.5%。男性风险从200磅男性患者的7%增加到600磅患者的13%。
体型较大的男性患者比体型较小的患者和/或女性患者发生严重危及生命并发症的风险更高。在本分析中，被认为可预测不良结局的风险因素，如吸烟史或糖尿病史，结果显示并无显著意义。老年患者并发症发生率相同，但死亡率高三倍，这表明他们缺乏从并发症中恢复的储备能力。
