Department of Surgery, University of California, Irvine School of Medicine, Irvine, California, USA.
Surg Obes Relat Dis. 2013 Mar-Apr;9(2):277-81. doi: 10.1016/j.soard.2012.01.025. Epub 2012 Mar 21.
Acute respiratory failure (ARF) can be a life-threatening postoperative complication after bariatric surgery and is defined as the presence of acute respiratory distress or pulmonary insufficiency. We sought to identify predictors of ARF in patients who underwent bariatric surgery.
Using the Nationwide Inpatient Sample database, from 2006 to 2008, the clinical data from morbidly obese patients who underwent bariatric surgery were examined. Multivariate regression analysis was performed to identify the independent factors predictive of ARF. The factors examined included patient characteristics, co-morbidities, payer type, teaching status of hospital, surgical techniques (laparoscopic versus open), and type of bariatric operation (gastric bypass versus nongastric bypass).
A total of 304,515 patients underwent bariatric surgery during the 3-year period. The overall ARF rate was 1.35%. The greatest rate of ARF (4.10%) was observed after open gastric bypass surgery. The ARF rate was lower after laparoscopic than after the open surgical technique (.94% versus 3.87%, respectively; P < .01) and after nongastric bypass versus gastric bypass (.82% versus 1.54%, respectively; P < .01). Using multivariate regression analysis, congestive heart failure (adjusted odds ratio [AOR] 5.1), open surgery (AOR 3.3), chronic renal failure (AOR 2.9), gastric bypass (AOR 2.5), peripheral vascular disease (AOR 2.4), male gender (AOR 1.9), age >50 years (AOR 1.8), Medicare payer (AOR 1.8), alcohol abuse (AOR 1.8), chronic lung disease (AOR 1.6), diabetes mellitus (AOR 1.2), and smoking (AOR 1.1) were factors associated with greater rates of ARF. Compared with patients without ARF, patients with ARF had significantly greater in-hospital mortality (5.69% versus .04%, P < .01).
We identified multiple risk factors that have an effect on the development of acute respiratory failure after bariatric surgery. Surgeons should consider these factors in surgical decision-making and inform patients of their risk of this potentially life-threatening complication.
急性呼吸衰竭（ARF）是肥胖症手术后危及生命的术后并发症，其定义为存在急性呼吸窘迫或肺功能不全。我们试图确定接受减肥手术患者发生 ARF 的预测因素。
使用 2006 年至 2008 年全国住院患者样本数据库，检查了接受减肥手术的病态肥胖患者的临床数据。采用多元回归分析确定预测 ARF 的独立因素。检查的因素包括患者特征、合并症、支付类型、医院教学状况、手术技术（腹腔镜与开放）以及减肥手术类型（胃旁路术与非胃旁路术）。
在 3 年期间，共有 304515 名患者接受了减肥手术。总体 ARF 发生率为 1.35%。开放式胃旁路手术后 ARF 发生率最高（4.10%）。与开放手术技术相比，腹腔镜手术的 ARF 发生率较低（分别为 0.94%和 3.87%；P <.01），非胃旁路术与胃旁路术相比（分别为 0.82%和 1.54%；P <.01）。使用多元回归分析，充血性心力衰竭（调整后比值比 [AOR] 5.1）、开放手术（AOR 3.3）、慢性肾衰竭（AOR 2.9）、胃旁路术（AOR 2.5）、外周血管疾病（AOR 2.4）、男性（AOR 1.9）、年龄>50 岁（AOR 1.8）、医疗保险支付方（AOR 1.8）、酒精滥用（AOR 1.8）、慢性肺部疾病（AOR 1.6）、糖尿病（AOR 1.2）和吸烟（AOR 1.1）是与 ARF 发生率较高相关的因素。与无 ARF 的患者相比，发生 ARF 的患者院内死亡率显著更高（5.69%比 0.04%，P <.01）。
我们确定了多个影响减肥手术后急性呼吸衰竭发展的危险因素。外科医生应在手术决策中考虑这些因素，并告知患者发生这种潜在危及生命的并发症的风险。
