Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg. 2013 Feb;257(2):279-86. doi: 10.1097/SLA.0b013e3182683037.
The objectives of this investigation were to (1) compare short-term outcomes for patients undergoing primary gastric bypass surgery with those who had gastric bypass procedures performed as a rescue procedure after failed gastric banding and (2) study trends in the frequency of reoperations between 2005 and 2008 for patients who had prior gastric banding.
The use of gastric banding to treat obesity has increased drastically in the United States. However, the frequency of reoperations related to gastric banding and associated short-term outcomes are unknown.
The Nationwide Inpatient Sample from 2005 to 2008 was used for this population-based study. Descriptive statistics as well as unadjusted and risk-adjusted generalized linear models were performed to assess adverse short-term outcomes.
A total of 66,303 patients were included in the analysis, 63,171 (95.3%) underwent a primary gastric bypass procedure and 3132 patients (4.7%) underwent a gastric band-related reoperation. Patients undergoing a gastric bypass procedure concomitant with a band-related reoperation had more intraoperative complications [risk-adjusted odds ratio (OR): 2.3, P = 0.002] and postoperative complications (risk-adjusted OR: 8.0, P < 0.001), were at higher risk of reoperations/reinterventions (risk-adjusted OR: 6.0, P < 0.001), increased length of hospital stay (adjusted mean difference: 0.89 days, P < 0.001), and higher hospital charges (adjusted mean difference: $13,257, P < 0.001). The number of gastric band-related reoperations increased from 579 in 2005 to 1132 in 2008 (196%).
The number of reoperations after gastric banding is rapidly increasing in the United States. To our knowledge, this is the first population-based study providing strong evidence that patients undergoing gastric bypass procedure after failed gastric banding have more adverse outcomes than those undergoing gastric bypass alone. The broad indication for gastric banding should be reaffirmed for the US population.
本研究旨在：(1)比较初次行胃旁路手术与胃旁路术作为胃束带术失败后挽救手术的患者的短期结果；(2)研究 2005 年至 2008 年期间既往行胃束带术患者再次手术的频率趋势。
在美国，胃束带术治疗肥胖症的应用急剧增加。然而，与胃束带术相关的再手术频率及其相关的短期结果尚不清楚。
本研究采用基于人群的 2005 年至 2008 年全国住院患者样本。采用描述性统计、未调整和风险调整的广义线性模型评估不良短期结果。
共纳入 66303 例患者，63171 例(95.3%)行初次胃旁路手术，3132 例(4.7%)行胃束带相关再手术。行胃旁路手术同时行胃束带相关再手术的患者术中并发症更多[风险调整比值比(OR)：2.3，P=0.002]和术后并发症(风险调整 OR：8.0，P<0.001)，再次手术/干预的风险更高(风险调整 OR：6.0，P<0.001)，住院时间延长(调整平均差异：0.89 天，P<0.001)，住院费用更高(调整平均差异：$13257，P<0.001)。2005 年胃束带相关再手术为 579 例，2008 年增加至 1132 例(196%)。
美国胃束带术再手术的数量正在迅速增加。据我们所知，这是第一项基于人群的研究，为胃旁路术失败后行胃旁路术的患者比单独行胃旁路术的患者有更多不良结局提供了有力证据。美国人群应对胃束带术的广泛适应证进行重新确认。
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