依赖氧的患者行减重手术的结局：MBSAQIP 数据库分析。

Bariatric surgery outcomes in oxygen-dependent patients: analysis of the MBSAQIP database.

机构信息

Department of Medicine, Nova Southeastern University, Fort Lauderdale, Florida.

Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Surg Obes Relat Dis. 2019 Sep;15(9):1571-1580. doi: 10.1016/j.soard.2019.06.030. Epub 2019 Jul 4.

DOI:10.1016/j.soard.2019.06.030

PMID:31399310

Abstract

BACKGROUND

The number of bariatric procedures performed on complex, oxygen-dependent patients has increased. These patients often have other medical co-morbidities that can be improved after bariatric surgery; however, questions remain regarding their perioperative risk.

OBJECTIVE

To assess the safety of bariatric surgery among oxygen-dependent patients, and to compare outcomes in this patient group after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy.

SETTING

University and private hospitals enrolled in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

METHODS

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2015 to 2017 was analyzed. A multivariable regression analysis was performed looking at 30-day serious complications for oxygen-dependent patients, with a secondary propensity-matched analysis performed comparing patients undergoing laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass.

RESULTS

In total, 430,396 patients were analyzed, 3034 (0.7%) of whom were oxygen dependent. The absolute 30-day complication rate among oxygen-dependent patients was more than twice as high (8.24% versus 3.46%, P < .001). The postoperative leak (.69% versus .41%, P = .017), bleed (2.08% versus .91%, P < .001), cardiac event (.16% versus .07%, P = .034), and pneumonia rate (.89% versus .19%, P < .001) were all significantly higher. Mortality was significantly higher among oxygen-dependent patients (.49% versus .09%, P < .001). On multivariable analysis, oxygen dependency was an independent predictor of adverse outcomes (odds ratio 1.30 [1.22-1.50], P < .001). Laparoscopic Roux-en-Y gastric bypass was associated with a statistically significant higher complication rate compared with laparoscopic sleeve gastrectomy (13.23% versus 5.16%, P < .001).

CONCLUSION

Oxygen-dependent patients undergoing bariatric surgery are at a higher risk of both morbidity and mortality postoperatively.

摘要

背景

接受减重手术的复杂、需吸氧患者数量有所增加。这些患者通常还存在其他可通过减重手术改善的合并症，但对于他们的围手术期风险仍存在疑问。

目的

评估需吸氧患者接受减重手术的安全性，并比较腹腔镜 Roux-en-Y 胃旁路术与腹腔镜袖状胃切除术在该患者人群中的术后结局。

设置

参与代谢和减重手术认证和质量改进计划数据登记处的大学和私立医院。

方法

分析 2015 年至 2017 年的代谢和减重手术认证和质量改进计划数据。对需吸氧患者的 30 天严重并发症进行多变量回归分析，并进行二次倾向匹配分析，比较行腹腔镜袖状胃切除术与腹腔镜 Roux-en-Y 胃旁路术的患者。

结果

共分析了 430396 例患者，其中 3034 例（0.7%）为需吸氧患者。需吸氧患者的绝对 30 天并发症发生率高出两倍以上（8.24%比 3.46%，P<0.001）。术后漏（0.69%比 0.41%，P=0.017）、出血（2.08%比 0.91%，P<0.001）、心脏事件（0.16%比 0.07%，P=0.034）和肺炎发生率（0.89%比 0.19%，P<0.001）均显著升高。需吸氧患者的死亡率也显著升高（0.49%比 0.09%，P<0.001）。多变量分析显示，需吸氧是不良结局的独立预测因素（比值比 1.30[1.22-1.50]，P<0.001）。与腹腔镜袖状胃切除术相比，腹腔镜 Roux-en-Y 胃旁路术与更高的并发症发生率相关（13.23%比 5.16%，P<0.001）。