Pradarelli Jason C, Varban Oliver A, Ghaferi Amir A, Weiner Matthew, Carlin Arthur M, Dimick Justin B
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, University of Michigan, Ann Arbor, MI.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Bariatric Surgery Collaborative.
Surgery. 2016 Apr;159(4):1113-20. doi: 10.1016/j.surg.2015.08.044. Epub 2015 Oct 23.
Laparoscopic sleeve gastrectomy has surpassed gastric bypass and laparoscopic adjustable gastric banding recently as the most common weight-loss procedure. Previously, substantial concerns existed regarding variation in perioperative safety with bariatric surgery. This study aimed to assess rates of perioperative complications for laparoscopic sleeve gastrectomy across hospitals and in relation to procedure volume within the Michigan Bariatric Surgery Collaborative.
We analyzed 8,693 patients who underwent laparoscopic sleeve gastrectomy from 2013 through 2014 across 40 hospitals in the Michigan Bariatric Surgery Collaborative. Mixed-effects logistic regression was used to assess hospital variation in risk- and reliability-adjusted rates of overall and serious 30-day complications and their relationship with hospital annual volume of stapling procedures (gastric bypass and sleeve gastrectomy).
Overall, 5.4% of patients experienced perioperative complications. Adjusted rates of overall complications varied three-fold across hospitals, ranging from 3.6% (95% confidence interval 1.9-6.8%) to 11.0% (95% confidence interval 7.7-15.5%). Serious complications occurred in just 1.2% of patients and varied minimally. In this analysis, hospital volume was not associated with overall or serious complications. The 1 hospital with significantly less overall complication rates was high-volume (≥ 125 procedures/year); however, of the 4 hospitals with significantly greater complication rates, 3 were medium-volume (50-124 procedures/year), and 1 was high-volume. The remaining hospitals were not significantly different than the cohort mean.
Serious complications among patients undergoing laparoscopic sleeve gastrectomy were relatively infrequent in this cohort of patients in the Michigan Bariatric Surgery Collaborative. Rates of overall complications varied widely across the hospitals enrolled in this statewide quality collaborative, although this variation was unrelated to volume standards required for accreditation as a comprehensive bariatric surgery center.
腹腔镜袖状胃切除术最近已超过胃旁路手术和腹腔镜可调节胃束带术，成为最常见的减肥手术。此前，人们对减肥手术围手术期安全性的差异存在重大担忧。本研究旨在评估密歇根减肥手术协作组中各医院腹腔镜袖状胃切除术的围手术期并发症发生率及其与手术量的关系。
我们分析了2013年至2014年期间在密歇根减肥手术协作组的40家医院接受腹腔镜袖状胃切除术的8693例患者。采用混合效应逻辑回归分析，评估各医院在风险和可靠性调整后的30天总体及严重并发症发生率的差异，以及它们与医院每年吻合器手术量（胃旁路手术和袖状胃切除术）的关系。
总体而言，5.4%的患者出现围手术期并发症。各医院总体并发症的调整发生率相差三倍，范围从3.6%（95%置信区间1.9 - 6.8%）到11.0%（95%置信区间7.7 - 15.5%）。严重并发症仅发生在1.2%的患者中，且差异极小。在本分析中，医院手术量与总体或严重并发症无关。总体并发症发生率显著较低的1家医院手术量较大（≥125例/年）；然而，在并发症发生率显著较高的4家医院中，3家为中等手术量（50 - 124例/年），1家为高手术量。其余医院与队列均值无显著差异。
在密歇根减肥手术协作组的这组患者中，接受腹腔镜袖状胃切除术的患者严重并发症相对较少。在这个全州范围的质量协作组中，各医院的总体并发症发生率差异很大，尽管这种差异与被认证为综合减肥手术中心所需的手术量标准无关。
