Weller Wendy E, Rosati Carl
Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York, University at Albany, Rensselaer, NY 12144-3456, USA.
Ann Surg. 2008 Jul;248(1):10-5. doi: 10.1097/SLA.0b013e31816d953a.
The objective of this study was to use nationally representative data to compare outcomes of open gastric bypass (OGB) versus laparoscopic gastric bypass (LGB) surgery.
The number of bariatric procedures continues to grow. Increasingly, these surgeries are being performed laparoscopically. However, few population-based studies have examined differences in outcomes between LGB and OGB surgeries. Population-based studies can provide further insight into differences in outcomes between open and laparoscopic bariatric procedures.
Using the Nationwide Inpatient Sample, we identified adults undergoing LGB or OGB surgery during 2005 (n = 19,156). Following preliminary descriptive statistics, multiple logistic and linear regressions were used to obtain risk-adjusted outcomes, including postoperative in-hospital complications, reoperation, length of stay, and total charges.
The majority of patients in the study sample (74.5%) underwent laparoscopic bypass surgery in 2005. After adjusting for patient and hospital level factors, patients undergoing OGB surgery were more likely to experience reoperation as well as the following complications: pulmonary (odds ratio [OR] = 1.92 (1.54-2.38), P < 0.001); cardiovascular (OR = 1.54 [1.07-2.23], P = 0.02); procedural (OR = 1.29 [1.06-1.57], P < 0.01); sepsis (OR = 2.18 [1.50-3.16], P < 0.001); and anastomotic leak (OR = 1.32 [1.02-1.71], P = 0.03). After risk adjustment, LGB was associated with a shorter length of stay but higher total charges.
Overall, LGB patients are less likely to experience reoperation and postoperative complications in the hospital and have a shorter length of stay but incur higher total charges than OGB patients.
本研究的目的是使用具有全国代表性的数据，比较开放式胃旁路手术（OGB）与腹腔镜胃旁路手术（LGB）的治疗效果。
减肥手术的数量持续增长。越来越多的此类手术通过腹腔镜进行。然而，很少有基于人群的研究探讨LGB和OGB手术在治疗效果上的差异。基于人群的研究可以进一步深入了解开放式和腹腔镜减肥手术在治疗效果上的差异。
利用全国住院患者样本，我们确定了2005年接受LGB或OGB手术的成年人（n = 19156）。在进行初步描述性统计后，使用多元逻辑回归和线性回归来获得风险调整后的结果，包括术后住院并发症、再次手术、住院时间和总费用。
研究样本中的大多数患者（74.5%）在2005年接受了腹腔镜旁路手术。在对患者和医院层面的因素进行调整后，接受OGB手术的患者更有可能经历再次手术以及以下并发症：肺部（优势比[OR]=1.92（1.54 - 2.38），P < 0.001）；心血管（OR = 1.54[1.07 - 2.23]，P = 0.02）；手术相关（OR = 1.29[1.06 - 1.57]，P < 0.01）；败血症（OR = 2.18[1.50 - 3.16]，P < 0.001）；以及吻合口漏（OR = 1.32[1.02 - 1.71]，P = 0.03）。经过风险调整后，LGB与较短的住院时间相关，但总费用较高。
总体而言，与OGB患者相比，LGB患者在医院再次手术和术后并发症的发生率较低，住院时间较短，但总费用较高。
