van Mil Stefanie R, Duinhouwer Lucia E, Mannaerts Guido H H, Biter L Ulas, Dunkelgrun Martin, Apers Jan A
Department of Surgery, Franciscus Gasthuis & Vlietland, PO Box 10900, 3004 BA, Rotterdam, The Netherlands.
Obes Surg. 2017 Dec;27(12):3102-3109. doi: 10.1007/s11695-017-2746-y.
Morbidly obese patients are at higher risk of complications after surgery. In bariatric surgery, pre- and intra-operative checklists are commonly used to identify high-risk patients preoperatively, to decrease the number of postoperative complications. This pilot study evaluates the effect of a postoperative checklist in bariatric surgery, addressing regularly measured parameters, on the occurrence and early recognition of complications.
An in-house developed postoperative checklist was used on the first postoperative day after bariatric surgery and included information on nausea, pain, temperature, heart rate, and laboratory markers. Complications were scored using the Clavien-Dindo (CD) classification, and three groups were formed: no complications (CD0), minor complications (CD1 and 2), and major complications (≥CD3a). Differences between groups were analyzed using nonparametric tests.
Six hundred ninety-four subjects were included (79.5% female, age 42.6 ± 10.8 years, BMI 43.8 ± 5.8 kg/m). Twenty-nine subjects developed major complications within 30 days postoperatively. There were no significant differences in baseline characteristics between groups. Subjects with major complications were less willing to be discharged due to complaints, compared to subjects with no or minor complications (14.8 vs. 3.6 and 4.6%, respectively) and had a higher decrease of hemoglobin level (0.8 vs. 0.6 and 0.65 mmol/l, respectively).
The patient's willingness for discharge, in combination with hemoglobin decrease, may be the best early predictors of major complications after bariatric surgery. This postoperative checklist may be an adequate instrument to identify patients who can be safely discharged home on the first postoperative day and thereby play a part in patient management after bariatric surgery.
病态肥胖患者术后并发症风险更高。在减肥手术中，术前和术中检查表通常用于术前识别高危患者，以减少术后并发症的数量。这项前瞻性研究评估了减肥手术后的术后检查表对常规测量参数的影响，以及对并发症发生和早期识别的影响。
在减肥手术后的第一天使用内部开发的术后检查表，其中包括恶心、疼痛、体温、心率和实验室指标等信息。并发症采用Clavien-Dindo（CD）分类进行评分，并分为三组：无并发症（CD0）、轻微并发症（CD1和2）和严重并发症（≥CD3a）。使用非参数检验分析组间差异。
纳入694名受试者（79.5%为女性，年龄42.6±10.8岁，BMI 43.8±5.8kg/m²）。29名受试者在术后30天内出现严重并发症。各组之间的基线特征无显著差异。与无并发症或轻微并发症的受试者相比，出现严重并发症的受试者因不适而更不愿意出院（分别为14.8%、3.6%和4.6%），且血红蛋白水平下降幅度更大（分别为0.8mmol/L、0.6mmol/L和0.65mmol/L）。
患者的出院意愿与血红蛋白下降相结合，可能是减肥手术后严重并发症的最佳早期预测指标。这份术后检查表可能是识别术后第一天可安全出院回家的患者的合适工具，从而在减肥手术后的患者管理中发挥作用。
