减重手术后胃肠道漏的危险因素：MBASQIP 分析。

Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis.

机构信息

Department of Surgery, University of California, Irvine School of Medicine, Orange, CA.

出版信息

J Am Coll Surg. 2018 Jul;227(1):135-141. doi: 10.1016/j.jamcollsurg.2018.03.030. Epub 2018 Mar 30.

DOI:10.1016/j.jamcollsurg.2018.03.030

PMID:29605723

Abstract

BACKGROUND

Gastrointestinal leak remains one of the most dreaded complications in bariatric surgery. We aimed to evaluate risk factors and the impact of common perioperative interventions on the development of leak in patients who underwent laparoscopic bariatric surgery.

STUDY DESIGN

Using the 2015 database of accredited centers, data were analyzed for patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (LRYGB). Emergent, revisional, and converted cases were excluded. Multivariate logistic regression was used to analyze risk factors for leak, including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study.

RESULTS

Data from 133,478 patients who underwent laparoscopic sleeve gastrectomy (n = 92,495 [69.3%]) and LRYGB (n = 40,983 [30.7%]) were analyzed. Overall leak rate was 0.7% (938 of 133,478). Factors associated with increased risk for leak were oxygen dependency (adjusted odds ratio [AOR] 1.97), hypoalbuminemia (AOR 1.66), sleep apnea (AOR 1.52), hypertension (AOR 1.36), and diabetes (AOR 1.18). Compared with LRYGB, laparoscopic sleeve gastrectomy was associated with a lower risk of leak (AOR 0.52; 95% CI 0.44 to 0.61; p < 0.01). Intraoperative provocative test was performed in 81.9% of cases and the leak rate was higher in patients with vs without a provocative test (0.8% vs 0.4%, respectively; p < 0.01). A surgical drain was placed in 24.5% of cases and the leak rate was higher in patients with vs without a surgical drain placed (1.6% vs 0.4%, respectively; p < 0.01). A swallow study was performed in 41% of cases and the leak rate was similar between patients with vs without swallow study (0.7% vs 0.7%; p = 0.50).

CONCLUSIONS

The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks.

摘要

背景

胃肠道漏仍然是减重手术中最可怕的并发症之一。我们旨在评估风险因素和常见围手术期干预措施对接受腹腔镜减重手术患者发生漏的影响。

研究设计

使用 2015 年认证中心数据库，对接受腹腔镜袖状胃切除术或 Roux-en-Y 胃旁路术（LRYGB）的患者进行数据分析。排除急诊、翻修和转换病例。使用多变量逻辑回归分析吻合口激发试验、放置手术引流管和术后吞咽研究对漏的影响。

结果

共分析了 133478 例接受腹腔镜袖状胃切除术（n=92495[69.3%]）和 LRYGB（n=40983[30.7%]）的患者数据。总体漏诊率为 0.7%（938/133478）。与漏诊风险增加相关的因素包括氧依赖（调整后优势比[OR]1.97）、低白蛋白血症（OR1.66）、睡眠呼吸暂停（OR1.52）、高血压（OR1.36）和糖尿病（OR1.18）。与 LRYGB 相比，腹腔镜袖状胃切除术发生漏的风险较低（OR0.52；95%CI0.44 至 0.61；p<0.01）。81.9%的病例进行了术中激发试验，有激发试验的患者漏诊率高于无激发试验的患者（分别为 0.8%和 0.4%；p<0.01）。24.5%的病例放置了手术引流管，放置引流管的患者漏诊率高于未放置引流管的患者（分别为 1.6%和 0.4%；p<0.01）。41%的病例进行了吞咽研究，有吞咽研究的患者漏诊率与无吞咽研究的患者相似（分别为 0.7%和 0.7%；p=0.50）。