Department of Surgery, Kern Medical, Bakersfield, California.
Department of Surgery, Kern Medical, Bakersfield, California.
Surg Obes Relat Dis. 2018 Mar;14(3):339-341. doi: 10.1016/j.soard.2017.12.007. Epub 2017 Dec 14.
Acute care surgeons care for the entire breadth of the American adult population, including obese patients. As the population gets heavier, more patients will present to acute case surgeons with nonbariatric surgical emergencies. Do these surgeons need bariatric training to properly care for obese population?
To evaluate our experience in obese population requiring acute surgery and compare outcomes based on surgeon expertise in bariatric surgery.
Community teaching hospital, United States.
Retrospective review of obese patients requiring acute surgical intervention. Surgeons were classified as bariatric surgeons (B, n = 2) versus nonbariatric surgeons (NB, n = 4). Demographic characteristics, co-morbidities, and outcomes based on surgeon training were compared.
Two hundred three patients comprised the cohort. The mean body mass index was 37 ±6 kg/m. The majority of procedures were laparoscopic (cholecystectomies n = 75, appendectomies n = 45). The remaining nonroutine laparoscopic cases were intestinal obstructions (n = 9), incarcerated hernias (n = 17), traumatic injuries (n = 48), and intestinal ischemia or perforation (n = 9). Bariatric surgeons performed 35% of cases, and risk profiles were similar between groups. Operative times were similar for cholecystectomies and appendectomies. Bariatric surgeons performed more nonroutine cases laparoscopically (7% B versus 2% NB, P = .001). Surgical site infections were low (2% B versus 4% NB, P = .4). Hospital length of stay was higher in the NB group at 9 ± 9 days versus 5 ± 4 days for B (P = .05). Mortality was 5%.
Acute surgical procedures were performed in obese patients. Bariatric expertise favorably affected length of stay and the application of laparoscopy. Bariatric expertise may improve outcomes in nonbariatric emergencies, but further study is warranted.
急性护理外科医生照顾美国所有成年人群，包括肥胖患者。随着人口体重增加，更多的患者将因非减肥手术急诊而就诊于急性外科医生。这些外科医生是否需要减肥手术培训才能正确照顾肥胖人群？
评估我们在需要急性手术的肥胖人群中的经验，并根据外科医生在减肥手术方面的专业知识比较结果。
美国社区教学医院。
回顾性分析需要急性手术干预的肥胖患者。外科医生分为减肥外科医生（B，n = 2）和非减肥外科医生（NB，n = 4）。比较了基于外科医生培训的人口统计学特征、合并症和结果。
共有 203 例患者纳入研究队列。平均体重指数为 37 ± 6 kg/m。大多数手术为腹腔镜（胆囊切除术 n = 75，阑尾切除术 n = 45）。其余非常规腹腔镜手术病例为肠梗阻（n = 9）、嵌顿疝（n = 17）、创伤性损伤（n = 48）和肠缺血或穿孔（n = 9）。减肥外科医生完成了 35%的病例，两组的风险特征相似。胆囊切除术和阑尾切除术的手术时间相似。减肥外科医生更多地在腹腔镜下进行非常规手术（7% B 与 2% NB，P =.001）。手术部位感染率较低（2% B 与 4% NB，P =.4）。NB 组的住院时间较长，为 9 ± 9 天，B 组为 5 ± 4 天（P =.05）。死亡率为 5%。
在肥胖患者中进行了急性外科手术。减肥手术专业知识有利于缩短住院时间和腹腔镜的应用。减肥手术专业知识可能改善非减肥紧急情况下的结果，但需要进一步研究。
