《减肥手术纵向评估研究》中胃旁路术与非胃旁路术初次和再次减重手术 30 天结局的比较。
Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study.
机构信息
Columbia University Medical Center, New York, New York, USA.
出版信息
Surg Obes Relat Dis. 2010 Jan-Feb;6(1):22-30. doi: 10.1016/j.soard.2009.10.007. Epub 2009 Nov 22.
BACKGROUND
The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States.
METHODS
Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days).
RESULTS
Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m(2), P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%).
CONCLUSION
Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.
背景
本研究旨在比较初次减重手术和再次减重手术的发病率和死亡率，并确定在减重手术纵向评估联盟中再次减重手术患者不良结局的临床预测因素。该研究为美国大学医院的多机构研究。
方法
对 LABS-1（安全性）队列的数据进行分析，排除初次胃带术患者。共纳入 3802 例 LABS-1 患者：3577 例初次手术，225 例再次手术。比较两组患者的人口统计学、临床、手术和 30 天结局数据。采用非线性混合效应逻辑回归模型识别不良结局（死亡、深静脉血栓形成、肺栓塞、再插管、再次手术或 30 天后出院）的独立危险因素。
结果
与再次手术患者相比，初次手术患者年龄更小（中位数年龄 44 岁比 49 岁，P＜0.0001），男性比例更高（20.5%比 12.7%，P=0.006），体重指数更高（中位数 47.3 千克/平方米比 41.2 千克/平方米，P＜0.0001），合并症更多（P＜0.0001），包括高血压（56.0%比 46.0%，P=0.0044）、糖尿病（35.7%比 20.0%，P＜0.0001）和睡眠呼吸暂停（50.3%比 27.2%，P＜0.0001）。再次手术的手术时间更长（中位数 181 分钟比 135 分钟，P＜0.0001），术中失血更多（中位数 100 毫升比＜50 毫升，P＜0.0001）。再次手术后不良结局更常见（15.1%比 5.3%，P＜0.0001，比值比 2.4，95%置信区间 1.6-3.6）。调整先前与不良结局相关的患者特征后，这种差异仍具有统计学意义（比值比 2.3，95%置信区间 1.5-3.8）。两组 30 天死亡率相似（0.4%）。
结论
再次减重手术虽无显著死亡率，但不良结局发生率高于初次减重手术。
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