Hutter Matthew M, Randall Sheldon, Khuri Shukri F, Henderson William G, Abbott William M, Warshaw Andrew L
Massachusetts General Hospital, Boston, 02114, USA.
Ann Surg. 2006 May;243(5):657-62; discussion 662-6. doi: 10.1097/01.sla.0000216784.05951.0b.
To compare laparoscopic versus open gastric bypass procedures with respect to 30-day morbidity and mortality rates, using multi-institutional, prospective, risk-adjusted data.
Laparoscopic Roux-en-Y gastric bypass for weight loss is being performed with increasing frequency, partly driven by consumer demand. However, there are no multi-institutional, risk-adjusted, prospective studies comparing laparoscopic and open gastric bypass outcomes.
A multi-institutional, prospective, risk-adjusted cohort study of patients undergoing laparoscopic and open gastric bypass procedures was performed from hospitals (n = 15) involved in the Private Sector Study of the National Surgical Quality Improvement Program (NSQIP). Data points have been extensively validated, are based on standardized definitions, and were collected by nurse reviewers who are audited for accuracy.
From 2000 to 2003, data from 1356 gastric bypass procedures was collected. The 30-day mortality rate was zero in the laparoscopic group (n = 401), and 0.6% in the open group (n = 955) (P = not significant). The 30-day complication rate was significantly lower in the laparoscopic group as compared with the open group: 7% versus 14.5% (P < 0.0001). Multivariate logistic regression analysis was performed to control for potential confounding variables and showed that patients undergoing an open procedure were more likely to develop a complication, as compared with patients undergoing an laparoscopic procedure (odds ratio = 2.08; 95% confidence interval, 1.33-3.25). Propensity score modeling revealed similar results. A prediction model was derived, and variables that significantly predict higher complication rates after gastric bypass included an open procedure, a high ASA class (III, IV, V), functionally dependent patient, and hypertension as a comorbid illness.
Multicenter, prospective, risk-adjusted data show that laparoscopic gastric bypass is safer than open gastric bypass, with respect to 30-day complication rate.
利用多机构、前瞻性、风险调整数据，比较腹腔镜胃旁路手术与开腹胃旁路手术的30天发病率和死亡率。
腹腔镜Roux-en-Y胃旁路减肥手术的实施频率越来越高，部分原因是消费者的需求。然而，尚无多机构、风险调整、前瞻性研究比较腹腔镜和开腹胃旁路手术的结果。
对参与国家外科质量改进计划（NSQIP）私营部门研究的医院（n = 15）中接受腹腔镜和开腹胃旁路手术的患者进行多机构、前瞻性、风险调整队列研究。数据点经过广泛验证，基于标准化定义，由经过准确性审核的护士审核员收集。
2000年至2003年，收集了1356例胃旁路手术的数据。腹腔镜组（n = 401）的30天死亡率为零，开腹组（n = 955）为0.6%（P = 无显著性差异）。腹腔镜组的30天并发症发生率显著低于开腹组：7% 对14.5%（P < 0.0001）。进行多变量逻辑回归分析以控制潜在的混杂变量，结果显示与接受腹腔镜手术的患者相比，接受开腹手术的患者更有可能发生并发症（优势比 = 2.08；95%置信区间，1.33 - 3.25）。倾向评分模型显示了类似的结果。得出了一个预测模型，胃旁路手术后显著预测较高并发症发生率的变量包括开腹手术、高ASA分级（III、IV、V级）、功能依赖患者以及高血压作为合并症。
多中心、前瞻性、风险调整数据表明，就30天并发症发生率而言，腹腔镜胃旁路手术比开腹胃旁路手术更安全。
