Department of Surgery, University of California Irvine Medical Center, Orange, California.
Center for Statistical Consulting, University of California at Irvine, Irvine, California.
Surg Obes Relat Dis. 2017 Oct;13(10):1723-1727. doi: 10.1016/j.soard.2017.07.021. Epub 2017 Jul 20.
Studies have shown conflicting effects of resident involvement on outcomes after laparoscopic bariatric surgery. Resident involvement may be a proxy for a teaching environment in which multiple factors affect patient outcomes. However, no study has examined outcomes of laparoscopic bariatric surgery based on hospital teaching status.
To compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between teaching hospitals (THs) and nonteaching hospitals (NTHs).
Retrospective review of a national database in the United States.
The Nationwide Inpatient Sample database (2011-2013) was reviewed for obese patients who underwent LRYGB or LSG. Patient demographic characteristics and outcomes were analyzed according to hospital teaching status. Primary outcome measures included risk-adjusted inpatient mortality and serious morbidity.
We analyzed 32,449 LRYGBs and 26,075 LSGs. There were 35,160 (60.1%) cases performed at THs and 23,364 (39.9%) cases performed at NTHs. At THs, the distribution of LRYGB versus LSG cases was 20,461 (58.2%) versus 14,699 (41.8%), respectively; at NTHs, the distribution was 11,988 (51.3%) versus 11,376 (48.7%), respectively. For LRYGB, there were no significant differences between THs versus NTHs in mortality (AOR 1.14; P = 0.99), but there was an increase in odds of serious morbidity at THs (AOR 1.36; P<0.001). For LSG, there were no significant differences between THs versus NTHs for mortality (AOR 1.15; P = 0.99) or serious morbidity (AOR 1.03; P = 0.99).
There is an association between THs and increased serious morbidity for LRYGB, but hospital teaching status has no effect on morbidity or mortality after LSG. Further research is warranted to elucidate the reasons for these associations.
研究表明，住院医师参与对腹腔镜减重手术后的结果有相互矛盾的影响。住院医师参与可能是一个教学环境的代表，其中多种因素影响患者的结果。然而，尚无研究根据医院的教学状态来检查腹腔镜减重手术的结果。
比较教学医院（TH）和非教学医院（NTH）之间腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和腹腔镜袖状胃切除术（LSG）的结果。
美国国家数据库的回顾性研究。
审查了 2011-2013 年全国住院患者样本数据库中接受 LRYGB 或 LSG 的肥胖患者。根据医院教学状态分析患者的人口统计学特征和结果。主要观察指标包括风险调整后的住院死亡率和严重发病率。
我们分析了 32449 例 LRYGB 和 26075 例 LSG。其中 35160 例（60.1%）在 TH 进行，23364 例（39.9%）在 NTH 进行。在 TH 中，LRYGB 与 LSG 病例的分布分别为 20461（58.2%）和 14699（41.8%）；在 NTH 中，分别为 11988（51.3%）和 11376（48.7%）。对于 LRYGB，TH 与 NTH 之间的死亡率无显著差异（AOR 1.14；P=0.99），但 TH 严重发病率的几率增加（AOR 1.36；P<0.001）。对于 LSG，TH 与 NTH 之间的死亡率（AOR 1.15；P=0.99）或严重发病率（AOR 1.03；P=0.99）无显著差异。
TH 与 LRYGB 严重发病率增加之间存在关联，但医院教学状态对 LSG 的发病率或死亡率没有影响。需要进一步研究阐明这些关联的原因。
