Sun Sun, Borisenko Oleg, Spelman Tim, Ahmed Ahmed R
Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden.
Health Outcomes and Economic Evaluation Research Group, Center for Healthcare Ethics, Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Obes Surg. 2018 Apr;28(4):1098-1108. doi: 10.1007/s11695-017-2978-x.
The objective of the study is to analyze procedural and safety outcomes associated with bariatric surgery and describe the characteristics of patients undertaking bariatric procedures in England between April 2006 and March 2012.
This is a retrospective cohort study of all adult patients in England diagnosed with obesity and undergoing bariatric surgery as a primary procedure in NHS-funded sites between April 2006 and March 2012 using data sourced from the Hospital Episode Statistics dataset. Length of stay (LOS), 30-day readmission, and post-surgery complication were analyzed as primary outcomes. Socio-demographic background, provider type, procedure volume, and comorbidities were all analyzed as potential explanatory variables.
Gastric bypass (GBP, 12,628) was the most utilized procedure, followed by gastric banding (GB, 6872) and sleeve gastrectomy (SG, 3251). The most prevalent comorbidity was type 2 diabetes (23%). Inpatient mortality was low (≤ 0.15%) for all procedure types. LOS and the risks of both post-operative complication and 30-day readmission were significantly lower for GB, relative to those for GBP and SG. Ethnicity, geographical area, surgery type, and volume were all associated with LOS, risk of readmission, and complication. Provider type and deprivation were further associated with LOS while age correlated with readmission only. An increasing comorbidity burden was associated with an increased risk of both readmission and complication.
Gastric bypass was the most frequently reported procedure in England across the observation period. While utilization across all procedure types increased between 2007 and 2010, overall uptake of bariatric surgery in England represents only a small proportion of the eligible population. Readmission and complication rates were lower for gastric banding relative to those for either gastric bypass or sleeve gastrectomy. The observed inpatient mortality rate was low across all procedure types.
本研究的目的是分析与减肥手术相关的手术过程和安全结果，并描述2006年4月至2012年3月期间在英格兰接受减肥手术的患者特征。
这是一项回顾性队列研究，研究对象为2006年4月至2012年3月期间在英国国民健康服务体系（NHS）资助的医疗机构中被诊断为肥胖并接受减肥手术作为主要治疗手段的所有成年患者，数据来源于医院事件统计数据集。住院时间（LOS）、30天再入院率和术后并发症被作为主要结果进行分析。社会人口统计学背景、医疗机构类型、手术量和合并症均被作为潜在的解释变量进行分析。
胃旁路手术（GBP，12628例）是最常用的手术方式，其次是胃束带术（GB，6872例）和袖状胃切除术（SG，3251例）。最常见的合并症是2型糖尿病（23%）。所有手术类型的住院死亡率都很低（≤0.15%）。相对于胃旁路手术和袖状胃切除术，胃束带术的住院时间以及术后并发症和30天再入院的风险显著更低。种族、地理区域、手术类型和手术量均与住院时间、再入院风险和并发症相关。医疗机构类型和贫困程度与住院时间进一步相关，而年龄仅与再入院相关。合并症负担加重与再入院和并发症风险增加相关。
在观察期内，胃旁路手术是英格兰报告最多的手术方式。虽然2007年至2010年期间所有手术类型的使用率都有所增加，但英格兰减肥手术的总体接受率仅占符合条件人群的一小部分。相对于胃旁路手术或袖状胃切除术，胃束带术的再入院率和并发症发生率更低。所有手术类型的观察到的住院死亡率都很低。
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