Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK.
Ann Surg. 2019 Nov;270(5):859-867. doi: 10.1097/SLA.0000000000003512.
To define "best possible" outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).
Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.
Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers' median values for respective quality indicators.
Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.
Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.ClinicalTrials.gov Identifier NCT03440138.
定义减重手术（BS）（Roux-en-Y 胃旁路术 [RYGB] 和袖状胃切除术 [SG]）的“最佳”结果。
迄今为止，尚未为明确低危肥胖患者的最佳手术结果确定参考值。因此，由于病例组合的异质性，不同中心和不同时间的结果比较受到阻碍。
在 2012 年 6 月至 2017 年 5 月期间，在三大洲的 19 家高容量学术中心进行了 39424 例择期 BS 手术，我们确定了 4120 例 RYGB 和 1457 例 SG 低危病例，这些病例定义为无先前腹部手术、伴随手术、糖尿病、睡眠呼吸暂停、心脏病、肾功能不全、炎症性肠病、免疫抑制、抗凝、BMI>50 kg/m 和年龄>65 岁。我们选择了涵盖围手术期的临床相关终点。使用综合并发症指数对并发症进行严重程度分级。基准值定义为各自质量指标的参与中心中位数的第 75 个百分位数。
患者主要为女性（78%），年龄 38±11 岁，基线 BMI 为 40.8±5.8 kg/m。在 90 天内，7.2%的 RYGB 和 6.2%的 SG 患者至少出现 1 种并发症，没有患者死亡（非基准病例的死亡率：0.06%）。两种手术后 90 天内再次入院的最常见原因是有症状的胆石症和原因不明的腹痛。术后 90 天，RYGB 和 SG 的基准值分别为 5.5%Clavien-Dindo 分级≥IIIa 并发症发生率、5.5%再入院率和综合并发症指数≤33.73，在至少出现 1 种≥II 级并发症的患者亚组中。
针对 BS 围手术期结果的基准截止值提供了手术质量指标的新工具，并可在质量改进周期中实施。临床试验.gov 标识符 NCT03440138。
