Spaniolas Konstantinos, Trus Thadeus L, Adrales Gina L, Quigley Maureen T, Pories Walter J, Laycock William S
Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, Department of Surgery, East Carolina University, Greenville, North Carolina.
Division of Minimally Invasive Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Surg Obes Relat Dis. 2014 Jul-Aug;10(4):584-8. doi: 10.1016/j.soard.2014.02.010. Epub 2014 Feb 24.
Even though the U.S. population is aging, outcomes of bariatric surgery in the elderly are not well defined. Current literature mostly evaluates the effects of gastric bypass (RYGB), with paucity of data on sleeve gastrectomy (SG). The objective of this study was to assess 30-day morbidity and mortality associated with laparoscopic SG in patients aged 65 years and over, in comparison to RYGB.
The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients aged 65 and over who underwent laparoscopic RYGB and SG between 2010 and 2011. Baseline characteristics and outcomes were compared. P value<.05 was considered significant. Odds ratios (OR) with 95% confidence interval (CI) were reported when applicable.
We identified 1005 patients. Mean body mass index was 44 ± 7. SG was performed in 155 patients (15.4%). The American Society of Anesthesiology physical classification of 3 or 4 was similar between the 2 groups (82.6% versus 86.7%, P = .173). Diabetes was more frequent in the RYGB group (43.2% versus 55.6%, P = .004). 30-day mortality (0.6% versus 0.6%, OR 1.1, 95% CI .11-9.49), serious morbidity (5.2% versus 5.6%, OR .91, 95% CI .42-0.96), and overall morbidity (9% versus 9.1%, OR 1.0, 95% CI .55-1.81) were similar.
In elderly patients undergoing laparoscopic bariatric surgery, SG is not associated with significantly different 30-day outcomes compared to RYGB. Both procedures are followed by acceptably low morbidity and mortality.
尽管美国人口正在老龄化，但老年患者接受减肥手术的结果尚未明确界定。目前的文献大多评估胃旁路手术（RYGB）的效果，而关于袖状胃切除术（SG）的数据较少。本研究的目的是评估65岁及以上患者接受腹腔镜SG与RYGB相比的30天发病率和死亡率。
查询国家外科质量改进计划（NSQIP）数据库，获取2010年至2011年间接受腹腔镜RYGB和SG的所有65岁及以上患者。比较基线特征和结果。P值<0.05被认为具有统计学意义。适用时报告比值比（OR）及其95%置信区间（CI）。
我们共识别出1005例患者。平均体重指数为44±7。155例患者（15.4%）接受了SG。两组患者美国麻醉医师协会身体状况分级为3或4的比例相似（82.6%对86.7%，P = 0.173）。RYGB组糖尿病患者更为常见（43.2%对55.6%，P = 0.004）。30天死亡率（0.6%对0.6%，OR 1.1，95% CI 0.11 - 9.49）、严重发病率（5.2%对5.6%，OR 0.91，95% CI 0.42 - 0.96）和总体发病率（9%对9.1%，OR 1.0，95% CI 0.55 - 1.81）相似。
在接受腹腔镜减肥手术的老年患者中，与RYGB相比，SG的30天结局无显著差异。两种手术的发病率和死亡率均较低，可接受。
