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肥胖症手术的术前多学科方案：巴西公共卫生系统的一项提议

Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System.

作者信息

Chaim Elinton Adami, Pareja José Carlos, Gestic Martinho Antonio, Utrini Murillo Pimentel, Cazzo Everton

机构信息

Departamento de Cirurgia, Faculdade de Ciências Médicas, UNICAMP, Campinas, SP, Brasil.

出版信息

Arq Gastroenterol. 2017 Jan-Mar;54(1):70-74. doi: 10.1590/S0004-2803.2017v54n1-14.

DOI:10.1590/S0004-2803.2017v54n1-14
PMID:28079244
Abstract

BACKGROUND

  • Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery.

OBJECTIVE

  • To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system.

METHODS

  • A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program.

RESULTS

  • There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group.

CONCLUSION

  • The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.
摘要

背景

减肥手术已成为病态肥胖的金标准治疗方法，但手术机会仍然难以获得，术后随访的依从性普遍较低。为了改善治疗效果、增加手术机会并优化随访，我们开发了一种减肥手术的多学科术前方法。

目的

确定该项目对巴西公共卫生系统中减肥手术效果的影响。

方法

对接受减肥手术术前多学科项目的个体进行前瞻性评估，并将其手术结果与在该项目开始前接受手术的个体的前瞻性收集历史数据库中观察到的结果进行比较。

结果

有176名个体接受了多学科项目，226名未接受。接受该项目的个体在以下变量的发生率上显著较低：住院时间；伤口裂开；伤口感染；肺部并发症；吻合口漏；肺血栓栓塞；败血症；切口疝；腹壁疝；再次手术；以及死亡率。该项目组的失访和减肥失败情况也显著较低。

结论

采用全面的术前多学科方法可显著改善术后效果以及术后随访的依从性。它是巴西公共卫生系统背景下一种可重复且可能有益的方法。

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