Eviva Bariatrics, Shoreline, Washington.
Eviva Bariatrics, Shoreline, Washington.
Surg Obes Relat Dis. 2017 Jul;13(7):1117-1121. doi: 10.1016/j.soard.2017.03.012. Epub 2017 Mar 27.
Procedures performed in ambulatory surgical centers (ASC) can provide several advantages over hospital-based surgery. Understandably, concerns have been raised regarding "high acuity" cases in the ASC setting. Recently the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) presented protocols for ASCs to follow, requiring them to perform only "low acuity" cases to be compliant with accreditation.
Assess the safety and efficacy of outpatient sleeve gastrectomy (SG) on the "high acuity patient" in a free-standing ASC.
Free-standing ASC, Eviva Bariatrics, Seattle, Washington.
Data were collected retrospectively for all patients who underwent sleeve gastrectomy from January 1, 2013 to December 31, 2015, n = 1112. Of those patients, 120 were classified as "high acuity."
Mean age was 51.7 years (24-73), mean body mass index was 42.4 (26.2-65.9). Mean operative time was 91 minutes. Five patients (4.2%) were readmitted within 30 days. Causes of re-admission were portal vein thrombosis (n = 2), intra-abdominal abscess (n = 1), infected hematoma (n = 1), and postoperative bleeding (n = 1). One patient (0.83%) was transferred from the ASC to a nearby hospital due to a postoperative bleed. One patient (0.83%) had a re-operation to evacuate a hematoma. One patient had a re-operation to wash out an infected hematoma. There were 0 confirmed staple line leaks. There were no open conversions and no deaths within 30 days or at 1 year. Follow-up was 83% (n = 100) at 6 months, and 65.0% at 1 year (n = 78).
Criteria such as age, body mass index, or prior bariatric surgery did not reflect worse outcomes in a specialized ASC. With experienced surgeons, appropriate protocols, and a consistent operative team, SG can be performed safely in a free-standing ASC on select "high acuity" patients.
在门诊外科中心 (ASC) 进行的手术比在医院进行的手术具有多项优势。可以理解的是，人们对 ASC 环境中的“高 acuity”病例提出了担忧。最近，代谢和减重手术认证和质量改进计划 (MBSAQIP) 为 ASC 制定了遵循的方案，要求他们只进行“低 acuity”病例，以符合认证要求。
评估在独立 ASC 中对“高 acuity”患者进行门诊袖状胃切除术 (SG) 的安全性和有效性。
独立 ASC，西雅图的 Eviva Bariatrics。
回顾性收集了 2013 年 1 月 1 日至 2015 年 12 月 31 日期间接受袖状胃切除术的所有患者的数据，共 1112 例。其中 120 例被归类为“高 acuity”。
平均年龄为 51.7 岁（24-73 岁），平均体重指数为 42.4（26.2-65.9）。平均手术时间为 91 分钟。有 5 例患者（4.2%）在 30 天内再次入院。再入院的原因是门静脉血栓形成（n = 2）、腹腔脓肿（n = 1）、感染性血肿（n = 1）和术后出血（n = 1）。有 1 例患者（0.83%）因术后出血从 ASC 转至附近医院。有 1 例患者（0.83%）需要再次手术以清除血肿。有 1 例患者需要再次手术冲洗感染性血肿。有 0 例确认吻合口漏。30 天内或 1 年内无开放性转换，无死亡。6 个月时的随访率为 83%（n = 100），1 年时的随访率为 65.0%（n = 78）。
在专门的 ASC 中，年龄、体重指数或先前的减重手术等标准并不能反映出较差的结果。有经验的外科医生、适当的方案和一致的手术团队，可以在特定的“高 acuity”患者中安全地在独立 ASC 中进行 SG。
