Skulsky Samuel L, Dang Jerry T, Switzer Noah J, Sharma Arya M, Karmali Shahzeer, Birch Daniel W
Department of Surgery, University of Ottawa, Loeb Research Building, 725 Parkdale Avenue, Office WM150B, Ottawa, ON, K1Y 4E9, Canada.
Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Surg Endosc. 2021 Dec;35(12):7163-7173. doi: 10.1007/s00464-020-08138-7. Epub 2020 Nov 5.
Bariatric surgery is an evidence-based approach for sustained weight loss in patients with severe obesity. The most common procedures in North America are the laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The Edmonton Obesity Staging System (EOSS) is a tool that assigns patients a score of 0 to 4 according to their obesity-related comorbidities and functional status. Previous research demonstrates that increasing EOSS score is associated with overall non-operative mortality risk.
We sought to assess the association of the EOSS with major 30-day postoperative complications following LSG or LRYGB.
Primary LSG or LRYGB patients were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Patients were assigned EOSS scores according to their comorbidities and functional limitations extracted from the database. Multivariable logistic regression analysis was conducted to evaluate the relationship between EOSS score, age, sex, BMI, type of procedure, or operative time with 30-day major complications.
From 2015 to 2017, 430,238 patients (79.4% female) who underwent primary LSG or LRYGB were identified. The relative frequencies of patients by EOSS score were: 0 and 1 (23.9%), 2 (62.8%), 3 (10.5%), and 4 (2.9%). Mean preoperative BMI was 45.4 (SD 7.9) kg/m and mean age was 44.6 (SD 12.0) years. The overall 30-day major complication rate was 3.5%. EOSS 2, 3, and 4 were significantly associated with major complications. The strongest associations with major complications were EOSS 4 (OR 2.30; 95% CI 2.11-2.51, p < 0.001) and LRYGB versus LSG (OR 2.03; 95% CI 1.97-2.11, p < 0.001). EOSS 3 and 4 were most strongly associated with death.
Higher EOSS scores are independently associated with 30-day major postoperative complications and mortality. The EOSS provides utility in staging patients and identifying those at greater risk of postoperative complications.
减重手术是一种基于证据的治疗重度肥胖患者持续减重的方法。北美最常见的手术是腹腔镜袖状胃切除术（LSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）。埃德蒙顿肥胖分期系统（EOSS）是一种根据患者与肥胖相关的合并症和功能状态为其分配0至4分的工具。先前的研究表明，EOSS评分的增加与总体非手术死亡风险相关。
我们试图评估EOSS与LSG或LRYGB术后30天主要并发症之间的关联。
从代谢与减重手术认证及质量改进计划数据登记处识别接受初次LSG或LRYGB手术的患者。根据从数据库中提取的患者合并症和功能限制为其分配EOSS评分。进行多变量逻辑回归分析以评估EOSS评分、年龄、性别、体重指数、手术类型或手术时间与30天主要并发症之间的关系。
2015年至2017年，共识别出430238例接受初次LSG或LRYGB手术的患者（79.4%为女性）。按EOSS评分划分的患者相对频率为：0分和1分（23.9%）、2分（62.8%）、3分（10.5%）和4分（2.9%）。术前平均体重指数为45.4（标准差7.9）kg/m²，平均年龄为44.6（标准差12.0）岁。总体30天主要并发症发生率为3.5%。EOSS 2分、3分和4分与主要并发症显著相关。与主要并发症关联最强的是EOSS 4分（比值比2.30；95%置信区间2.11-2.51，p<0.001）以及LRYGB与LSG相比（比值比2.03；95%置信区间1.97-2.11，p<0.001）。EOSS 3分和4分与死亡关联最为密切。
较高的EOSS评分与术后30天主要并发症及死亡率独立相关。EOSS在对患者进行分期以及识别术后并发症风险较高的患者方面具有实用价值。
