Department of Surgery, Michigan Medicine, Ann Arbor, MI.
Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
Surgery. 2019 Nov;166(5):873-878. doi: 10.1016/j.surg.2019.07.003. Epub 2019 Aug 23.
Sleeve gastrectomy has become the most common procedure performed for weight loss. But emerging data indicate that this procedure can result in lifestyle-limiting gastroesophageal reflux disease. The influence of these gastroesophageal reflux disease symptoms on patient satisfaction with the procedure has not been explored.
Using a statewide, bariatric-specific data registry, we studied 6,608 patients who underwent laparoscopic sleeve gastrectomy from 2013 to 2017. We used the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire, which is 10 questions, each ranging from 0 (no symptoms) to 5 (severe symptoms). To assess the impact of sleeve gastrectomy on patient satisfaction, we calculated the change in this score at baseline versus 1 year after the procedure. We stratified the change in the gastroesophageal reflux disease score into 5 even-sized groups (quintiles). We then examined the relationship between change in the gastroesophageal reflux disease score and patient satisfaction at 1 year. We used generalized linear mixed models to assess the variation in patient satisfaction explained by the change in the gastroesophageal reflux disease score, excess body weight loss at 1 year, and other patient outcomes (serious complications, readmission, and reoperations). We controlled for patient factors (age, sex, race, and comorbidities) and year of sleeve gastrectomy.
The average change in the gastroesophageal reflux disease score was 1.62 (range: -48 to 48); however, the change in the gastroesophageal reflux disease score varied across quintiles with a -7.3-point (range: -48 to -3) worsening in the bottom quintile versus a 2.6-point (range: 7 to 48) improvement in the top quintile. Overall, 77.7% of patients were satisfied, but the proportion of patients satisfied was highly dependent on whether their reflux symptoms improved or worsened. Only 48.9% in the bottom quintile were satisfied, compared with 78.1% in the top quintile (<.0001). In the multivariate model, changes in patient-reported gastroesophageal reflux disease score were the most predictive of patient satisfaction, explaining 10.1% of the variation in 1 year satisfaction. Among patients in the bottom quintile, reflux symptoms explained 30.2% of variation compared with 2.3% in quintiles with little change or improvement in reflux. Moreover, excess body weight loss explained only 2% of variation in satisfaction and <1% was explained by patient outcomes (serious complications, readmissions, reoperations, or surgical complications).
In this statewide study of sleeve gastrectomy, we demonstrated that gastroesophageal reflux symptoms are an important determinant of 1 year satisfaction, particularly among patients whose symptoms worsened the most.
胃袖状切除术已成为最常见的减重手术。但新出现的数据表明，该手术可导致限制生活方式的胃食管反流病。胃食管反流病症状对患者对手术的满意度的影响尚未得到探讨。
我们使用全州范围的减重特定数据登记处，研究了 2013 年至 2017 年期间接受腹腔镜胃袖状切除术的 6608 名患者。我们使用了胃食管反流病健康相关生活质量问卷，该问卷包含 10 个问题，每个问题的分值范围为 0（无症状）至 5（严重症状）。为了评估胃袖状切除术对患者满意度的影响，我们计算了该评分在基线时与术后 1 年时的变化。我们将胃食管反流病评分的变化分为 5 个均匀大小的组（五分位数）。然后，我们检查了胃食管反流病评分变化与术后 1 年患者满意度之间的关系。我们使用广义线性混合模型来评估胃食管反流病评分变化、术后 1 年时多余体重减轻以及其他患者结局（严重并发症、再入院和再次手术）解释患者满意度变化的差异。我们控制了患者因素（年龄、性别、种族和合并症）和胃袖状切除术的年份。
胃食管反流病评分的平均变化为 1.62（范围：-48 至 48）；然而，胃食管反流病评分的变化在五分位数之间存在差异，最低五分位数的评分恶化了 7.3 分（范围：-48 至-3），而最高五分位数的评分改善了 2.6 分（范围：7 至 48）。总体而言，77.7%的患者感到满意，但患者满意度的比例高度取决于他们的反流症状是改善还是恶化。在最低五分位数中，只有 48.9%的患者感到满意，而在最高五分位数中，这一比例为 78.1%（<.0001）。在多变量模型中，患者报告的胃食管反流病评分变化是患者满意度的最具预测性指标，解释了 1 年满意度变化的 10.1%。在最低五分位数的患者中，反流症状解释了 30.2%的变化，而在反流症状变化不大或改善的五分位数中，这一比例为 2.3%。此外，多余体重减轻仅解释了满意度变化的 2%，而<1%的满意度变化可由患者结局（严重并发症、再入院、再次手术或手术并发症）解释。
在这项全州范围的胃袖状切除术研究中，我们证明了胃食管反流症状是 1 年满意度的一个重要决定因素，特别是在那些症状恶化最严重的患者中。
