Brolin Robert E, Cody Ronald P, Marcella Stephen W
Department of Surgery; University Medical Center of Princeton at Plainsboro, Plainsboro, New Jersey.
Rutgers School of Public Health, Piscataway, New Jersey.
Surg Obes Relat Dis. 2015 Nov-Dec;11(6):1201-6. doi: 10.1016/j.soard.2015.02.001. Epub 2015 Feb 9.
The Obesity Surgery Mortality Risk Score (OS-MRS) was developed to ascertain preoperative mortality risk of patients having bariatric surgery. To date there has not been a comparison between open and laparoscopic operations using the OS-MRS.
To determine whether there are differences in mortality risk between open and laparoscopic Roux-en-Y Gastric Bypass (RYGB) using the OS-MRS.
Three university-affiliated hospitals.
The 90-day mortality of 2467 consecutive patients who had primary open (1574) or laparoscopic (893) RYGB performed by one surgeon was determined. Univariate and multivariate analysis using 5 OS-MRS risk factors including body mass index (BMI) gender, age>45, presence of hypertension and preoperative deep vein thrombosis (DVT) risk was performed in each group. Each patient was placed in 1 of 3 OS-MRS risk classes based on the number of risks: A (0-1), B (2-3), and C (4-5).
Preoperative BMI and DVT risk factors were significantly greater in the open group (OG). Preoperative age was significantly greater in the laparoscopic group (LG). There were significantly more class B and C patients in LG. Ninety-day mortality rates for OG and LG patients were 1.0% and .9%, respectively. Pulmonary embolism was the most common cause of death. All deaths in LG occurred during first 4 years of that experience. Mortality rate by class was A = .1%; B = 1.5%; C = 2.3%. The difference in mortality between class B and C patients was not significant. Univariate analysis in the OG indicated that BMI, age, gender, and DVT risk were significant predictors of mortality. In the LG only BMI and DVT were significant predictors of death. Presence of hypertension was not a significant predictor in either group. Multivariate analysis excluding hypertension found that age was predictive of mortality in the OG while BMI (P = .057) and gender (P = .065) approached statistical significance. Conversely, only BMI was predictive of mortality in the LG with age approaching significance (P = .058). In multivariate analysis DVT risk was not predictive of mortality in either group.
There are significant differences in the predictive value of the OS-MRS between open and laparoscopic RYGB. Although laparoscopic patients were significantly older versus the open patients, age was not predictive of mortality after laparoscopic RYGB. BMI trended toward increased mortality risk in both groups. Changes in technique and protocol likely contributed toward no mortality during the last 6 years of our laparoscopic experience.
肥胖症手术死亡率风险评分（OS-MRS）用于确定接受减肥手术患者的术前死亡风险。迄今为止，尚未使用OS-MRS对开放手术和腹腔镜手术进行比较。
使用OS-MRS确定开放和腹腔镜Roux-en-Y胃旁路术（RYGB）之间的死亡风险是否存在差异。
三家大学附属医院。
确定由一名外科医生连续进行的2467例初次开放（1574例）或腹腔镜（893例）RYGB患者的90天死亡率。每组使用包括体重指数（BMI）、性别、年龄>45岁、高血压的存在和术前深静脉血栓形成（DVT）风险在内的5个OS-MRS风险因素进行单因素和多因素分析。根据风险数量，将每位患者分为3个OS-MRS风险类别之一：A（0-1）、B（2-3）和C（4-5）。
开放手术组（OG）术前BMI和DVT风险因素显著更高。腹腔镜手术组（LG）术前年龄显著更大。LG组中B类和C类患者明显更多。OG组和LG组患者的90天死亡率分别为1.0%和0.9%。肺栓塞是最常见的死亡原因。LG组所有死亡均发生在该经验的前4年。按类别划分的死亡率为：A = 0.1%；B = 1.5%；C = 2.
