Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon; Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon.
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Surg Obes Relat Dis. 2018 Oct;14(10):1463-1470. doi: 10.1016/j.soard.2018.06.023. Epub 2018 Jul 3.
Laparoscopic sleeve gastrectomy (SG) has become the most popular bariatric operation over the last decade. Extreme obesity and increasing age have been generally associated with higher risks of complications after bariatric surgery. The postoperative risk for complications after SG has not been previously presented according to simultaneous grouping of body mass index (BMI) and age.
We aim to explore the association of age and BMI in determining the postoperative risk of SG from a national perspective.
The American College of Surgeons National Surgical Quality Improvement Program database.
We analyzed patient characteristics and operative outcomes of the 2010 to 2013 SG cohort available in the American College of Surgeons National Surgical Quality Improvement Program (N = 21,131). Patients were grouped based on age and BMI: young-obese (N = 10,291; <50 yr, BMI <0 kg/m; reference group), young-super-obese (N = 3594; <50 yr and BMI ≥50 kg/m), older-obese (N = 5636; ≥50 yr, BMI <0 kg/m), and older-super-obese (N = 1610; ≥50 yr, BMI ≥50 kg/m). Composite morbidity and/or mortality (M&M) was used as the primary outcome and risk-adjusted odds ratios (AOR[M&M]) were derived by logistic regression. M&M was a composite of surgical site, renal, neurologic, cardiac, thromboembolic, respiratory, septic and bleeding complications, unplanned readmissions, prolonged stay, and death.
Overall operative mortality was low (.1%) but significantly worse in older-super-obese patients (.37%; P = .005). M&M rates were lowest in young-obese (5.8%), similarly worse in young-super-obese (7.0%) and older-obese (7.0%), and highest for older-super-obese (10.1%; P < .001). After comprehensive covariate risk adjustment, the composite M&M outcome after SG was significantly increased (42%) only in older-super-obese patients (AOR = 1.42 [1.16-1.73]), while older age alone (AOR = 1.09 [.94-1.25]) and super obesity alone (AOR = 1.09 [.93-1.28]) did not.
Analysis of the American College of Surgeons National Surgical Quality Improvement Program showed that super obesity is associated with increased complications in older patients undergoing SG. Older-super-obese patients should be appropriately counseled about increased SG perioperative risks within the context of expected long-term benefits.
腹腔镜袖状胃切除术（SG）在过去十年中已成为最受欢迎的减肥手术。肥胖症和年龄增长通常与减肥手术后并发症的风险增加有关。以前没有根据体重指数（BMI）和年龄同时分组来报告 SG 术后并发症的风险。
我们旨在从全国角度探讨年龄和 BMI 对 SG 术后风险的关联。
美国外科医师学会国家手术质量改进计划数据库。
我们分析了美国外科医师学会国家手术质量改进计划（2010 年至 2013 年 SG 队列）中可用的患者特征和手术结果（n=21131）。患者根据年龄和 BMI 分组：年轻肥胖组（n=10291；<50 岁，BMI<0kg/m；参考组）、年轻超级肥胖组（n=3594；<50 岁，BMI≥50kg/m）、老年肥胖组（n=5636；≥50 岁，BMI<0kg/m）和老年超级肥胖组（n=1610；≥50 岁，BMI≥50kg/m）。复合发病率和/或死亡率（M&M）为主要结局，采用 logistic 回归得出风险调整比值比（AOR[M&M]）。M&M 是手术部位、肾脏、神经、心脏、血栓栓塞、呼吸、感染性和出血性并发症、计划外再入院、延长住院时间和死亡的综合表现。
总体手术死亡率较低（0.1%），但老年超级肥胖患者的死亡率明显更高（0.37%；P=0.005）。年轻肥胖组的 M&M 发生率最低（5.8%），年轻超级肥胖组和老年肥胖组的 M&M 发生率相似（7.0%），老年超级肥胖组的 M&M 发生率最高（10.1%；P<0.001）。在综合协变量风险调整后，仅老年超级肥胖患者的 SG 后复合 M&M 结局显著增加（42%）（AOR=1.42[1.16-1.73]），而年龄增长（AOR=1.09[0.94-1.25]）和超级肥胖（AOR=1.09[0.93-1.28]）本身并不增加。
美国外科医师学会国家手术质量改进计划的分析表明，超级肥胖与老年患者 SG 术后并发症的增加有关。对于接受 SG 的超级肥胖老年患者，应在预期长期获益的背景下，适当告知其围手术期风险增加的情况。
