全国范围内对特定患者在减重手术后第 1 天出院的安全性分析。
A Nationwide Safety Analysis of Discharge on the First Postoperative Day After Bariatric Surgery in Selected Patients.
机构信息
Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.
Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, OK, USA.
出版信息
Obes Surg. 2019 Jan;29(1):15-22. doi: 10.1007/s11695-018-3489-0.
BACKGROUND
Enhanced recovery after surgery has led to early recovery and shorter hospital stay after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). This study aims to assess feasibility and outcomes of postoperative day (POD) 1 discharge after LRYGB and LSG from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset.
METHODS
Patients who underwent elective LRYGB and LSG and were discharged on POD 1 and 2 were extracted from the MBSAQIP dataset. A 1:1 propensity score matching was performed between cases with POD 1 vs POD 2 discharge, and the 30-day outcomes of the cohorts were compared.
RESULTS
A total of 80,464 patients met the study criteria: 8862 LRYGB and 31,370 LSG cases, which were discharged on POD 1, and matched 1:1 with those discharged on POD 2. Within the LRYGB cohort, patients discharged on POD 2 had higher all-cause morbidity (7.5% vs 6.1%; p < 0.001) and 30-day re-intervention (2.0% vs 1.5%; p = 0.004) in comparison with patients discharged on POD 1. There were no statistical differences with respect to serious morbidity (0.5% vs 0.4%; p = 0.15), 30-day readmission (4.9% vs 4.5%; p = 0.2), and 30-day reoperation (1.3% vs 1.2%; p = 0.7). Within the LSG cohort, patients discharged on POD 2 had higher all-cause morbidity (4.2% vs 3.4%; p < 0.001), serious morbidity (0.4% vs 0.3%; p < 0.001), 30-day re-intervention (1.0% vs 0.6%; p < 0.001), and 30-day readmission (2.9% vs 2.5%; p = 0.002) in comparison with patients discharged on POD 1.
CONCLUSIONS
Early discharge on POD 1 may be safe in a selective group of bariatric patients without significant comorbidities.
背景
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和腹腔镜袖状胃切除术（LSG）后，加速康复外科已导致术后恢复加快和住院时间缩短。本研究旨在从代谢和减重手术质量改进计划（MBSAQIP）2015 年数据库评估 LRYGB 和 LSG 术后第 1 天出院的可行性和结局。
方法
从 MBSAQIP 数据库中提取出择期行 LRYGB 和 LSG 且术后第 1 天和第 2 天出院的患者。对第 1 天和第 2 天出院的病例进行 1:1 倾向评分匹配，并比较两组患者的 30 天结局。
结果
共有 80464 例患者符合研究标准：8862 例 LRYGB 和 31370 例 LSG，分别于术后第 1 天和第 2 天出院，并与术后第 2 天出院的患者进行 1:1 匹配。在 LRYGB 组中，与术后第 1 天出院的患者相比，术后第 2 天出院的患者总并发症发生率（7.5% vs 6.1%；p<0.001）和 30 天再干预率（2.0% vs 1.5%；p=0.004）更高。但两组严重并发症发生率（0.5% vs 0.4%；p=0.15）、30 天再入院率（4.9% vs 4.5%；p=0.2）和 30 天再次手术率（1.3% vs 1.2%；p=0.7）无统计学差异。在 LSG 组中，与术后第 1 天出院的患者相比，术后第 2 天出院的患者总并发症发生率（4.2% vs 3.4%；p<0.001）、严重并发症发生率（0.4% vs 0.3%；p<0.001）、30 天再干预率（1.0% vs 0.6%；p<0.001）和 30 天再入院率（2.9% vs 2.5%；p=0.002）更高。
结论
在没有明显合并症的选择性肥胖患者中，术后第 1 天提前出院可能是安全的。
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