Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; The Bariatric Center, Department of General Surgery, Cleveland Clinic Akron General, Akron, Ohio.
Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
Surg Obes Relat Dis. 2018 May;14(5):652-657. doi: 10.1016/j.soard.2018.01.008. Epub 2018 Jan 12.
National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health.
To quantify the impact of specific bariatric surgery complications on key clinical outcomes.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated.
In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality.
This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery VTE has the greatest potential to reduce mortality and readmission rates.
为了降低减重手术对关键结局不良事件的负担，已经实施了国家质量计划。然而，对于哪些并发症对患者健康的影响最大，还不是很清楚。
量化特定减重手术并发症对关键临床结局的影响。
代谢和减重手术认证和质量改进计划（MBSAQIP）数据库。
从 MBSAQIP 2015 参与者使用文件中检索接受主要减重手术的患者数据。使用风险调整的人群归因分数估计 8 种特定并发症（出血、静脉血栓栓塞[VTE]、漏、伤口感染、肺炎、尿路感染、心肌梗死和中风）对 5 个主要 30 天结局（终末器官功能障碍、再次手术、重症监护病房入院、再次入院和死亡率）的影响。人群归因分数是一种计算指标，考虑了每种并发症的流行率和严重程度。人群归因分数表示如果消除该并发症，给定结局将减少的百分比。
共纳入 135413 例接受袖状胃切除术（67%）、Roux-en-Y 胃旁路术（29%）、可调胃带术（3%）和十二指肠转位术（1%）的患者。最常见的并发症是出血（0.7%）、伤口感染（0.5%）、尿路感染（0.3%）、VTE（0.3%）和漏（0.2%）。出血和漏是 5 个检查结局中 3 个的最大贡献者。VTE 对再入院和死亡率的影响最大。
本研究量化了特定并发症对减重手术后关键手术结局的影响。出血和漏是减重手术后终末器官功能障碍、再次手术和重症监护病房入院的总体影响最大的并发症。此外，我们的研究结果表明，针对减少减重手术后 VTE 的举措最有可能降低死亡率和再入院率。
