Temple University/St Luke's University Health Network School of Medicine, Philadelphia, Pennsylvania; St. Luke's University Health Network, Fountain Hill, Pennsylvania.
St. Luke's University Health Network, Fountain Hill, Pennsylvania.
Surg Obes Relat Dis. 2018 May;14(5):545-551. doi: 10.1016/j.soard.2018.01.011. Epub 2018 Jan 13.
BACKGROUND: According to recent American Society for Metabolic and Bariatric Surgery estimates, sleeve gastrectomy (SG) is now the most commonly performed procedure in the United States (~53.8% of all bariatric procedures), followed by Roux-en-Y gastric bypass (RYGB; 23.1% of all procedures). OBJECTIVES: The objective of this study was to evaluate outcomes and safety of these 2 procedures in the first 30 days postoperatively using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. SETTING: University health network, United States. METHODS: We reviewed all SG and RYGB cases entered between January 1 and December 31, 2015 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ, or Fisher's exact tests as appropriate, with P<.05 denoting statistical significance and no adjustment for multiple testing. RESULTS: A total of 141,646 patients were analyzed; 98,292 underwent SG and 43,354 underwent RYGB. Average age was 44.5 and 45.4 years for SG and RYGB, respectively. Preoperative body mass index was 45.1 and 46.1 for SG and RYGB, respectively. The 30-day mortality was .1% for SG and .2% for RYGB (P<.05). The incidence of unplanned intensive care unit admission after RYGB was twice as high compared with SG (1.3% versus .6%, respectively, P<.05). The incidence of at least 1 intervention or reoperation after RYGB was significantly higher compared with SG (2.8% and 2.5% for GB versus 1.2% and 1% for SG, P<.05). After RYGB, .4% of patients had a drain left in place at 30 days postoperatively versus .3% for SG (P<.05). The incidence of readmission was 2.8% for RYGB and 1.2% for SG (P<.05). CONCLUSIONS: The incidence of postoperative complications in the first 30 days after surgery is low for both RYGB and SG. However, SG seems to have a better safety profile in the first 30 days postoperatively compared with RYGB. These findings should be considered in the preoperative evaluation and counseling of bariatric patients. Long-term follow-up is needed to compare safety and efficacy of SG versus RYGB.
背景：根据美国代谢和减重外科学会最近的估计，袖状胃切除术（SG）现在是美国最常进行的手术（~53.8%的减重手术），其次是 Roux-en-Y 胃旁路术（RYGB；所有手术的 23.1%）。 目的：本研究旨在使用代谢和减重外科学会认证和质量改进计划数据登记处评估这两种手术术后 30 天内的结果和安全性。 设置：美国大学健康网络。 方法：我们回顾了 2015 年 1 月 1 日至 12 月 31 日期间在代谢和减重外科学会认证和质量改进计划数据登记处录入的所有 SG 和 RYGB 病例。根据单独的 Mann-Whitney 秩和检验、χ²或 Fisher 确切检验分析人口统计学特征和 30 天结果，P<.05 表示统计学意义，不进行多次检验调整。 结果：共分析了 141646 例患者；98292 例行 SG，43354 例行 RYGB。SG 和 RYGB 的平均年龄分别为 44.5 岁和 45.4 岁。SG 和 RYGB 的术前体重指数分别为 45.1 和 46.1。SG 的 30 天死亡率为.1%，RYGB 为.2%（P<.05）。RYGB 术后 ICU 入住率是 SG 的两倍（分别为 1.3%和.6%，P<.05）。RYGB 术后至少一次干预或再次手术的发生率明显高于 SG（GB 为 2.8%和 2.5%，SG 为 1.2%和 1%，P<.05）。RYGB 术后 30 天有 0.4%的患者留置引流管，而 SG 为 0.3%（P<.05）。RYGB 的再入院率为 2.8%，SG 为 1.2%（P<.05）。 结论：RYGB 和 SG 术后 30 天内并发症的发生率均较低。然而，SG 在术后 30 天内的安全性似乎优于 RYGB。这些发现应在术前评估和咨询减重患者时考虑。需要长期随访以比较 SG 与 RYGB 的安全性和疗效。
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