Department of Surgery, Stony Brook University, Stony Brook, New York.
Division of Foregut, Bariatric and Advanced GI Surgery, Department of Surgery, Stony Brook University, Stony Brook, New York.
Surg Obes Relat Dis. 2018 Apr;14(4):517-520. doi: 10.1016/j.soard.2017.12.023. Epub 2018 Jan 3.
Although multiple studies demonstrate that routine postoperative contrast studies have a low yield in diagnosing patients with early gastrointestinal (GI) leak after bariatric surgery, the practice pattern is unknown. Additionally, routine imaging may hinder procedural pathways that lead to accelerated postoperative discharge.
To report on the nationwide use of routine upper GI studies (UGI) and evaluate the effect on hospital resource utilization.
Nationwide analysis of accredited centers.
The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was used to identify patients who underwent routine UGI after nonrevisional Roux-en-Y gastric bypass or sleeve gastrectomy. Multivariable logistic regression models were developed to identify risk factors for early hospital discharge.
Bariatric surgery was performed on 130,686 patients. Routine UGI was performed in 30.9% of Roux-en-Y gastric bypass and 43% of sleeve gastrectomy patients (P<.0001). Patients undergoing routine UGI were less likely to be discharged by postoperative day 1 (odds ratio .7, 95%; confidence interval .69-0.72). There was no difference in postoperative leak rate between the routine UGI versus nonroutine UGI group (.7% versus .8%, P = .208). Among patients who developed a GI leak, there was no significant difference in the rate of reoperation, readmission, and reintervention between the 2 groups. The time interval between index operation and any further management for the leak was longer in the routine UGI group.
Routine UGI evaluation after bariatric surgery remains a common practice in accredited centers. This practice is associated with prolonged hospital length of stay, with no effect on the diagnosis of leak rate.
尽管多项研究表明，常规术后对比研究在诊断减重手术后早期胃肠道（GI）漏的患者方面效果不佳，但这种做法的实际情况尚不清楚。此外，常规影像学检查可能会阻碍导致术后加速出院的治疗途径。
报告全国范围内常规上消化道造影（UGI）的使用情况，并评估其对医院资源利用的影响。
认证中心的全国性分析。
使用代谢和减重手术认证质量和改进计划公共使用文件，确定 2015 年接受非修正式 Roux-en-Y 胃旁路术或袖状胃切除术的患者进行常规 UGI 的情况。采用多变量逻辑回归模型确定早期出院的风险因素。
共对 130686 名患者进行了减重手术。Roux-en-Y 胃旁路术和袖状胃切除术患者中，常规 UGI 的使用率分别为 30.9%和 43%（P<.0001）。进行常规 UGI 的患者在术后第 1 天出院的可能性较小（优势比.7，95%置信区间.69-0.72）。常规 UGI 组和非常规 UGI 组的术后漏诊率无差异（分别为 0.7%和 0.8%，P=.208）。在发生 GI 漏的患者中，常规 UGI 组和非常规 UGI 组在再手术、再入院和再干预的发生率方面无显著差异。常规 UGI 组发生漏诊的患者接受进一步治疗的时间间隔较长。
在认证中心，常规评估减重手术后的 UGI 仍是一种常见做法。这种做法与住院时间延长有关，但对漏诊率无影响。
