University of Minnesota, Minneapolis, MN, USA.
Obes Surg. 2013 Nov;23(11):1718-26. doi: 10.1007/s11695-013-1001-4.
We hypothesized that patients undergoing Roux-en-Y gastric bypass (RYGB) with concomitant cholecystectomy (RYGB + C) would be at greater risk for adverse events compared to patients undergoing RYGB alone.
Patients who underwent a RYGB were identified in the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program Database. Multivariate logistic regression with adjustment for confounding variables was utilized to identify risk factors for mortality at 30 days, major adverse events, and prolonged length of stay (PLOS).
We identified 32,946 patients who underwent RYGB; of these, 1,731 (5.2%) underwent RYGB + C. Overall, RYGB + C was a risk factor for predicting major adverse events following laparoscopic but not open procedures. Regardless of approach, PLOS was more common among RYGB + C patients following adjustment. Overall mortality at 30 days was low and did not vary with concomitant cholecystectomy following adjustment.
The risk for major adverse events is significantly greater for RYGB + C patients following laparoscopic procedures, and the risk for PLOS is greater for RYGB + C patients following both open and laparoscopic procedures. The short-term risks identified in this study can assist in decision-making when considering concomitant cholecystectomy at the time of RYGB.
我们假设与单独进行 Roux-en-Y 胃旁路术（RYGB）相比，同时行胆囊切除术（RYGB+C）的患者发生不良事件的风险更高。
在美国外科医师学会国家手术质量改进计划数据库中确定了 2005-2009 年接受 RYGB 的患者。利用多变量逻辑回归分析，并进行混杂变量调整，以确定 30 天内死亡率、主要不良事件和延长住院时间（PLOS）的风险因素。
我们确定了 32946 例接受 RYGB 的患者；其中 1731 例（5.2%）同时行 RYGB+C。总体而言，RYGB+C 是预测腹腔镜下但不是开腹手术后发生主要不良事件的危险因素。无论手术方式如何，调整后 RYGB+C 患者的 PLOS 更为常见。调整后，30 天的总体死亡率较低，且与胆囊切除术后无差异。
与单独进行腹腔镜 RYGB 相比，腹腔镜 RYGB+C 患者发生主要不良事件的风险显著增加，且无论手术方式如何，RYGB+C 患者的 PLOS 风险更高。本研究中确定的短期风险有助于在考虑 RYGB 时同时行胆囊切除术时做出决策。
