肥胖症手术治疗后住院时间的预测因素：英国一家三级中心的回顾性研究。
Factors Predicting Length of Stay Following Bariatric Surgery: Retrospective Review of a Single UK Tertiary Centre Experience.
机构信息
North Midlands Institute of Metabolic & Bariatric Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
出版信息
Obes Surg. 2018 Jul;28(7):1924-1930. doi: 10.1007/s11695-017-3105-8.
BACKGROUND
Laparoscopic Roux Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed bariatric procedures. Improvement in techniques and perioperative management of patients have resulted in shorter hospital stay and reduced overall costs. Many post-operative protocols aspire to post-operative day 1 discharge with studies showing reduction in length of stay without increasing complications. In this study, we investigate the factors predictive of early discharge at our high-volume bariatric centre.
METHODS
A retrospective review of all patients who underwent bariatric surgery (RYGB or SG) at a single centre between January 2013 and December 2014 was undertaken. Routine preoperative investigations were performed and patient discussed at bariatric MDT. Post-operative management was as per standard protocols. Demographic data, type of surgery and post-operative data (length of stay, complications, readmission, reoperations) were analysed. Statistical analysis was performed using SPSS.
RESULTS
Five hundred six patients underwent RYGB (407 (80.4%)) or SG (99 (19.6%)). The mean preoperative BMI was 45.9 (range 33.3-80.6). The median length of stay was 1 day (range 1-214 days; interquartile range 1-2 days) for RYGB and 2 days (range 1-8 days; interquartile range 1-3 days) for SG. Two hundred sixty-eight (52.9%) patients were discharged on post-operative day 1. The type of surgery and preoperative BMI were the only significant factors predicative of day 1 discharge after surgery. Patients undergoing SG were 3.3 times more likely to stay longer than 1 day after surgery (p < 0.001). BMI < 50 is associated with day 1 discharge (p = 0.030).
CONCLUSION
Early discharge, on post-operative day 1 appears to be safe and is not associated with a greater risk of readmission. Sleeve gastrectomy and a BMI > 50 are associated with an increased risk of failure to achieve day 1 discharge.
背景
腹腔镜 Roux Y 胃旁路术（RYGB）和腹腔镜袖状胃切除术（LSG）是最常进行的减肥手术。手术技术和患者围手术期管理的改进导致住院时间缩短，总费用降低。许多术后方案都希望在术后第一天出院，研究表明，在不增加并发症的情况下，住院时间缩短。在这项研究中，我们在高容量减肥中心调查了预测早期出院的因素。
方法
回顾性分析了 2013 年 1 月至 2014 年 12 月期间在单中心接受减肥手术（RYGB 或 SG）的所有患者。进行了常规术前检查，并在减肥多学科治疗小组中讨论了患者情况。术后管理按照标准方案进行。分析了人口统计学数据、手术类型和术后数据（住院时间、并发症、再入院、再手术）。使用 SPSS 进行统计分析。
结果
506 例患者接受了 RYGB（407 例[80.4%]）或 SG（99 例[19.6%]）。术前平均 BMI 为 45.9（范围 33.3-80.6）。RYGB 的中位住院时间为 1 天（范围 1-214 天；四分位距 1-2 天），SG 为 2 天（范围 1-8 天；四分位距 1-3 天）。268 例（52.9%）患者术后第 1 天出院。手术类型和术前 BMI 是唯一与术后第 1 天出院相关的显著预测因素。SG 患者术后住院时间超过 1 天的可能性是 RYGB 患者的 3.3 倍（p<0.001）。BMI<50 与术后第 1 天出院相关（p=0.030）。
结论
术后第 1 天的早期出院似乎是安全的，并且与再入院的风险增加无关。袖状胃切除术和 BMI>50 与无法实现第 1 天出院的风险增加相关。
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