Saleh Fady, Doumouras Aristithes G, Gmora Scott, Anvari Mehran, Hong Dennis
Division of General Surgery (Saleh, Doumouras, Gmora, Anvari, Hong), St. Joseph's Healthcare; Department of Surgery (Doumouras, Gmora, Anvari, Hong), McMaster University, Hamilton, Ont.
CMAJ Open. 2016 Aug 4;4(3):E383-E389. doi: 10.9778/cmajo.20150112. eCollection 2016 Jul-Sep.
Bariatric surgery centres of excellence are relatively new in Canada and were first started in Ontario in 2009. This study presents short-term outcomes of Canada's largest bariatric collaborative, from Ontario, during its first 3 years.
We performed a population-based cohort study that included all patients (age ≥ 18) who received a Roux-en-Y gastric bypass or sleeve gastrectomy for the purpose of weight loss from March 2009 to April 2012 within Ontario. Data were derived from the Canadian Institute for Health Information Discharge Abstract and Hospital Morbidity Databases. Primary outcomes included short-term overall complication rate, reoperation rate, anastomotic leak rate and death. Hierarchical logistic regression was used to identify risk factors for overall complications. A median odds ratio (OR) was used to compare risk-adjusted complication rates across centres of excellence.
A total of 5007 procedures (91.7% Roux-en-Y gastric bypass, 8.3% sleeve gastrectomy) were performed during the 3-year study period, with an overall complication rate of 11.7% (95% confidence interval [CI] 10.8%-12.6%). The leak rate was 0.84% (95% CI 0.61%-1.13%), the reoperation rate was 4.6% (95% CI 4.0%-5.2%) and mortality was 0.16% (95% CI 0.07%-0.31%). Male sex, chronic kidney disease and osteoarthritis were identified as risk factors for overall complications ( value < 0.05). The median ORs across centres of excellence, calculated for both overall complications and reoperation rate, were 1.76 and 1.49, respectively.
Bariatric surgery within Ontario has similar short-term outcomes to those of other major world centres. The variability of outcomes within centres of excellence highlights areas for program quality improvement.
加拿大的卓越减重手术中心相对较新，2009年在安大略省首次设立。本研究呈现了来自安大略省的加拿大最大减重协作组在其成立头3年的短期结果。
我们开展了一项基于人群的队列研究，纳入了2009年3月至2012年4月在安大略省内为减重目的接受 Roux-en-Y 胃旁路术或袖状胃切除术的所有患者（年龄≥18岁）。数据来源于加拿大卫生信息研究所出院摘要和医院发病率数据库。主要结局包括短期总体并发症发生率、再次手术率、吻合口漏发生率和死亡率。采用分层逻辑回归确定总体并发症的危险因素。使用中位数比值比（OR）比较各卓越中心经风险调整后的并发症发生率。
在3年研究期间共进行了5007例手术（91.7%为 Roux-en-Y 胃旁路术，8.3%为袖状胃切除术），总体并发症发生率为11.7%（95%置信区间[CI] 10.8% - 12.6%）。漏发生率为0.84%（95% CI 0.61% - 1.13%），再次手术率为4.6%（95% CI 4.0% - 5.2%），死亡率为0.16%（95% CI 0.07% - 0.31%）。男性、慢性肾病和骨关节炎被确定为总体并发症的危险因素（ 值<0.05）。各卓越中心总体并发症和再次手术率的中位数OR分别为1.76和1.49。
安大略省的减重手术短期结果与世界其他主要中心相似。卓越中心内结果的变异性突出了项目质量改进的领域。
