Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Division of General Surgery, Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Obes Surg. 2021 Feb;31(2):675-681. doi: 10.1007/s11695-020-04939-w. Epub 2020 Aug 21.
Given there are approximately 100,000 primary laparoscopic sleeve gastrectomy (LSG) procedures performed a year in North America, there is a need to evaluate recent trends in LSG. The objective of this study was to analyze the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to identify trends in technical factors and patient outcomes over time.
The MBSAQIP prospectively collects data from 854 centers in the USA and Canada. Patients undergoing primary LSG were included. Statistical analysis was performed to characterize trends in patient factors, technical factors, and 30-day postoperative outcomes.
A total of 434,030 patients underwent primary LSG. The mean age was 44.2 (SD 12.0) years and mean body mass index was 45.1 (SD 7.8) kg/m. Baseline demographics did not vary appreciably by year. Operative time decreased from 2015 to 2018 (75.4 to 70.6 min, p < 0.001). Bougie size and stapling distance from the pylorus did not change by year. However, staple line reinforcement (66.8 to 63.2%, p < 0.001) and oversewing of the staple line (23.1 to 20.1%, p < 0.001) were less commonly performed. Postoperatively, from 2015 to 2018, there was a 45.8% relative reduction in leaks (0.48 to 0.26%, p < 0.001). There were also reductions in 30-day major complications (2.87 to 2.28%, p < 0.001), length of stay (1.72 to 1.44 days, p < 0.001), and readmissions (3.39 to 2.77%, p < 0.001).
From 2015 to 2018, there was a decrease in staple line reinforcement and oversewing. These changes correlated with reductions in operative time, length of stay, readmission, and major complications.
在北美，每年大约有 100,000 例腹腔镜袖状胃切除术（LSG），因此需要评估 LSG 的最新趋势。本研究的目的是分析代谢和减重手术认证和质量改进计划（MBSAQIP），以确定随时间推移技术因素和患者结局的趋势。
MBSAQIP 从美国和加拿大的 854 个中心前瞻性收集数据。纳入接受初次 LSG 的患者。对患者因素、技术因素和 30 天术后结局的趋势进行统计学分析。
共 434,030 例患者接受了初次 LSG。平均年龄为 44.2（SD 12.0）岁，平均体重指数为 45.1（SD 7.8）kg/m2。基线人口统计学特征在不同年份无明显差异。手术时间从 2015 年到 2018 年减少（75.4 分钟至 70.6 分钟，p<0.001）。扩张器尺寸和吻合器距幽门的距离在不同年份无变化。然而，吻合线加固（66.8%至 63.2%，p<0.001）和吻合线缝合（23.1%至 20.1%，p<0.001）的应用减少。术后，2015 年至 2018 年，漏诊率相对降低了 45.8%（0.48%至 0.26%，p<0.001）。30 天主要并发症（2.87%至 2.28%，p<0.001）、住院时间（1.72 天至 1.44 天，p<0.001）和再入院率（3.39%至 2.77%，p<0.001）也有所降低。
从 2015 年到 2018 年，吻合线加固和缝合的应用减少。这些变化与手术时间、住院时间、再入院率和主要并发症的减少相关。
