Zafar Syed Nabeel, Shockcor Nicole, Prasad Nikhil, Wise Eric S, Jackson Hope T, Kligman Mark
Department of Surgery, University of Maryland Medical Center, Baltimore, MD.
Surg Laparosc Endosc Percutan Tech. 2019 Feb;29(1):53-57. doi: 10.1097/SLE.0000000000000598.
Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the analysis. A total of 710 (1.25%) patient suffered a POB. The independent odds of POB were 38% lower for patients having LSG compared with those having LRYGB (odds ratio, 0.62; 95% confidence interval=0.51-0.76). This difference is more pronounced with intraoperative securing of the staple line. Appropriate measures to reduce POB after each type of bariatric procedure is warranted.
减肥手术后减少术后出血（POB）的措施偏向于腹腔镜袖状胃切除术（LSG）。我们使用2015年代谢与减肥手术认证及质量改进计划（MBSAQIP）来描述LSG与腹腔镜Roux-en-Y胃旁路术（LRYGB）之间出血率的差异。倾向评分匹配和多变量逻辑回归检验了POB率的独立差异。在数据集中共识别出来自742个中心的168,093名患者。经过筛选，36,925例LRYGB患者和20,020例LSG患者被纳入分析。共有710名（1.25%）患者发生POB。与接受LRYGB的患者相比，接受LSG的患者发生POB的独立几率低38%（比值比，0.62；95%置信区间=0.51-0.76）。术中固定吻合钉线时，这种差异更为明显。每种减肥手术术后都需要采取适当措施来减少POB。
