Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina 27705, USA.
Surg Obes Relat Dis. 2012 Nov-Dec;8(6):671-7. doi: 10.1016/j.soard.2012.07.020. Epub 2012 Sep 11.
There is now sufficient demand for bariatric surgery to compare bariatric surgeons and bariatric centers according to their postsurgical outcomes, but few validated risk stratification measures are available to enable valid comparisons. The purpose of this study was to develop and validate a risk stratification model of composite adverse events related to Roux-en-Y gastric bypass (RYGB) surgery.
The study population included 36,254 patients from the Bariatric Outcomes Longitudinal Database (BOLD) registry who were 18-70 years old and had RYGB between June 11, 2007, and December 2, 2009. This population was randomly divided into a 50% testing sample and a 50% validation sample. The testing sample was used to identify significant predictors of 90-day composite adverse events and estimate odds ratios, while the validation sample was used to assess model calibration. After validating the fit of the risk stratification model, the testing and validation samples were combined to estimate the final odds ratios.
The 90-day composite adverse event rate was 1.48%. The risk stratification model of 90-day composite adverse events included age (40-64, ≥ 65), indicators for male gender, body mass index (50-59.9, ≥ 60), obesity hypoventilation syndrome, back pain, diabetes, pulmonary hypertension, ischemic heart disease, functional status, and American Society of Anesthesiology classes 4 or 5. Our final gastric bypass model was predictive (c-statistic = .68) of serious adverse events 90 days after surgery.
With additional validation, this risk model can inform both the patient and surgeon about the risks of bariatric surgery and its different procedures, as well as enable valid outcomes comparisons between surgeons and surgical programs.
现在对减重手术的需求很大，需要根据手术后的结果来比较减重外科医生和减重中心，但可用的验证风险分层措施很少，无法进行有效的比较。本研究的目的是开发和验证与 Roux-en-Y 胃旁路术（RYGB）相关的复合不良事件的风险分层模型。
研究人群包括来自 Bariatric Outcomes Longitudinal Database（BOLD）注册中心的 36254 名年龄在 18-70 岁之间、2007 年 6 月 11 日至 2009 年 12 月 2 日期间接受 RYGB 的患者。该人群被随机分为 50%的测试样本和 50%的验证样本。测试样本用于确定 90 天复合不良事件的显著预测因素并估计优势比，而验证样本用于评估模型校准度。在验证风险分层模型拟合度后，将测试和验证样本合并以估计最终的优势比。
90 天复合不良事件发生率为 1.48%。90 天复合不良事件的风险分层模型包括年龄（40-64、≥65）、男性性别指标、体重指数（50-59.9、≥60）、肥胖通气不足综合征、背痛、糖尿病、肺动脉高压、缺血性心脏病、功能状态和美国麻醉医师协会分类 4 或 5。我们最终的胃旁路模型对术后 90 天严重不良事件具有预测性（c 统计量=0.68）。
经过进一步验证，该风险模型可以为患者和外科医生提供有关减重手术及其不同程序风险的信息，并能够在外科医生和手术计划之间进行有效的结果比较。
