Lyn-Sue Jerome R, Doble Justin A, Juza Ryan M, Alli Vamsi V
Department of Surgery, The Pennsylvania State University, College of Medicine. Hershey, Pennsylvania, USA.
JSLS. 2018 Apr-Jun;22(2). doi: 10.4293/JSLS.2017.00096.
The prevalence of patients with a history of bariatric surgery is climbing. Medical and surgical questions arising in this patient population may prompt them to present to the nearest emergency department (ED), irrespective of that facility's experience with bariatric surgery. The emergency physician is the first to evaluate patients with a history of bariatric surgery who present with abdominal symptoms. As a quality improvement project aimed at reducing resource utilization, we sought to determine which patients presenting to the ED could be treated in an outpatient setting in lieu of hospital admission.
We conducted a retrospective review of bariatric patients admitted from our ED with abdominal symptoms, including abdominal pain, nausea, vomiting, dysphagia, obstruction, and hematemesis. We collected the following variables: type of bariatric operation, admission and discharge diagnoses, and all interventions performed during admission.
One hundred sixty-nine patients (76.1%) had a history of laparoscopic Roux-en-Y gastric bypass. The time from bariatric operation to presentation averaged 42 ± 4.63 (SD) months. The most common symptom was abdominal pain (80.2%). Ninety-four percent of patients underwent invasive management via upper endoscopy, laparoscopy, or laparotomy. The most common postprocedural diagnoses were stricture, bowel obstruction, inflammatory findings, and cholecystitis.
Most patient encounters resulted in invasive management (204/282; 72.3%). The subset of these patients requiring endoscopic evaluation or therapy (37.7%) may be suitable for outpatient management if appropriate measures are available for rapid follow-up and procedural scheduling.
接受过减肥手术的患者数量正在攀升。这一患者群体出现的医学和外科问题可能促使他们前往最近的急诊科就诊，而不论该机构对减肥手术的经验如何。急诊医生是首位评估有减肥手术史且出现腹部症状患者的医生。作为一项旨在减少资源利用的质量改进项目，我们试图确定哪些到急诊科就诊的患者可以在门诊治疗而非住院。
我们对从急诊科收治的有腹部症状（包括腹痛、恶心、呕吐、吞咽困难、梗阻和呕血）的减肥手术患者进行了回顾性研究。我们收集了以下变量：减肥手术类型、入院和出院诊断以及入院期间进行的所有干预措施。
169名患者（76.1%）有腹腔镜Roux-en-Y胃旁路手术史。从减肥手术到就诊的时间平均为42±4.63（标准差）个月。最常见的症状是腹痛（80.2%）。94%的患者通过上消化道内镜检查、腹腔镜检查或剖腹手术接受了侵入性治疗。术后最常见的诊断是狭窄、肠梗阻、炎症表现和胆囊炎。
大多数患者就诊后接受了侵入性治疗（204/282；72.3%）。如果有适当措施可用于快速随访和手术安排，这些需要内镜评估或治疗的患者子集（37.7%）可能适合门诊治疗。
