Department of Gastrointestinal, Metabolic, and Surgical Oncology (DCVMC). Multidisciplinary unit of obesity surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, 11 allée du morvan, 54511, Vandoeuvre-les-Nancy, France.
INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France.
Obes Surg. 2020 Sep;30(9):3378-3386. doi: 10.1007/s11695-020-04570-9.
Data about incidence and severity of reoperations up to 6 months after bariatric surgery are currently limited. The aim of this cohort study was to evaluate the incidence and severity of reoperations after initial bariatric surgical procedures and to compare this between the 3 most frequent current surgical procedures (sleeve, gastric bypass, gastric banding).
Nationwide observational cohort study using data from French Hospital Information System (2013-2015) to evaluate incidence and severity of reoperations within 6 months after bariatric surgery. Hazard ratios (HR) of longitudinal comparison between historical propensity-matched cohorts were estimated from a Fine and Gray's model using competing risk of death.
Cumulative reoperation rates increased from postoperative day-30 to day-180. Consequently, 31.1 to 90.0% of procedures would have been missed if the reoperation rate was based solely on a 30-day follow-up. Reoperation rate at 6 months was significantly higher after gastric bypass than after sleeve (HR 0.64; IC 95% [0.53-0.77]) and corresponded to moderate-risk reoperations (HR 0.65; IC 95% [0.53-0.78]). Reoperation rate at 6 months was significantly higher after gastric banding than after sleeve (HR 0.08; IC 95% [0.07-0.09]) and corresponded to moderate-risk reoperations (HR 0.08; IC 95% [0.07-0.10]).
Cumulative incidence of reoperations increased from 30 days to 6 months after sleeve, gastric bypass, or gastric banding and corresponded to moderate-risk surgical procedures. Consequently, 30-day reoperation rate should no longer be considered when evaluating complications and surgical performance after bariatric surgery.
目前，有关减重手术后 6 个月内再次手术的发生率和严重程度的数据有限。本队列研究的目的是评估初次减重手术后再次手术的发生率和严重程度，并比较三种最常见的当前手术（袖状胃切除术、胃旁路术和胃束带术）之间的差异。
本研究采用法国医院信息系统（2013-2015 年）的数据进行全国性观察性队列研究，以评估减重手术后 6 个月内再次手术的发生率和严重程度。使用 Fine-Gray 模型的竞争风险，从历史倾向匹配队列的纵向比较中估计危险比（HR）。
累积再手术率从术后第 30 天增加到第 180 天。因此，如果仅基于 30 天随访来计算再手术率，将会错过 31.1%至 90.0%的手术。胃旁路术后 6 个月的再手术率明显高于袖状胃切除术（HR 0.64；95%置信区间[0.53-0.77]），且为中度风险再手术（HR 0.65；95%置信区间[0.53-0.78]）。胃束带术后 6 个月的再手术率明显高于袖状胃切除术（HR 0.08；95%置信区间[0.07-0.09]），且为中度风险再手术（HR 0.08；95%置信区间[0.07-0.10]）。
袖状胃切除术、胃旁路术和胃束带术后 30 天至 6 个月的再手术累积发生率增加，且与中度风险手术相关。因此，在评估减重手术后的并发症和手术效果时，不应再考虑 30 天再手术率。
