Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France.
UMR INSERM 1086 "Cancers et préventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen cedex, France.
Obes Surg. 2021 Jul;31(7):3053-3064. doi: 10.1007/s11695-021-05367-0. Epub 2021 Apr 28.
Bariatric surgery may be associated with severe postoperative complications (SPC). Factors associated with the risk of SPC have not been fully investigated.
This study aimed to identify preoperative risk factors of SPC within 90 days and to develop a risk prediction model based on these factors.
We conducted a retrospective single-center cohort study based on a prospectively maintained database of obese patients undergoing laparoscopic bariatric surgery from October 2005 to May 2019. All SPC occurring up to the 90th postoperative day were recorded according to the Dindo-Clavien classification. Associations between potential risk factors and SPC were analyzed using a logistic regression model, and the risk prediction ("OS-SEV90 score") was computed. Based on the OS-SEV90 score, the patients were grouped into 3 categories of risk: low, intermediate, and high.
Among 1963 consecutive patients, no patient died and 82 (4.2%) experienced SPC within 90 days. History of gastric or esophageal surgery (adjusted odds ratio (aOR) 3.040, 95% confidence interval; CI 1.78-5.20, p< 0.0001), past of thromboembolic event aOR 2.26, 95%; CI 1.12-4.55, p = 0.0225), and surgery performed by a junior surgeon (aOR 1.99, 95%; CI 1.26-3.13, p = 0.003) were all independently associated with risk for SPC, adjusting for ASA physical status system (ASA) score ≥ 3, severe OSA, psychiatric disease, asthma, a history of abdominal surgery, alcohol, cardiac disease, and dyslipidemia. "the OS-SEV90 score" based on these factors was constructed to classify patients into 3 risk groups: low (≤2), intermediate (3-4), and high (≥5). According to "the OS-SEV90 score," SPC increased significantly from 2.9% in the low-risk group, 7.7% in the intermediate-risk group, and 23.3% in the high-risk group.
A predictive model of SPC within 90 days "the OS-SEV90 score" has been developed using 9 baseline risk factors. The use of the OS-SEV90 score may help the multidisciplinary team to identify the specific risk of each patient and inform them about and optimize the comorbidities before the surgery. Further studies are warranted to validate this score in a new independent cohort before using it in clinical practice.
减重手术可能与严重的术后并发症（SPC）有关。与 SPC 风险相关的因素尚未得到充分研究。
本研究旨在确定 90 天内 SPC 的术前危险因素，并基于这些因素建立风险预测模型。
我们进行了一项回顾性单中心队列研究，基于 2005 年 10 月至 2019 年 5 月接受腹腔镜减重手术的肥胖患者前瞻性维护的数据库。根据 Dindo-Clavien 分类，记录了 90 天术后所有 SPC。使用逻辑回归模型分析潜在危险因素与 SPC 之间的关系，并计算风险预测值（"OS-SEV90 评分"）。根据 OS-SEV90 评分，将患者分为低危、中危和高危 3 个风险组。
在 1963 例连续患者中，无患者死亡，82 例（4.2%）在 90 天内发生 SPC。胃或食管手术史（调整后的优势比（aOR）3.040，95%置信区间；CI 1.78-5.20，p<0.0001）、血栓栓塞事件史（aOR 2.26，95%；CI 1.12-4.55，p=0.0225）和初级外科医生手术（aOR 1.99，95%；CI 1.26-3.13，p=0.003）在调整 ASA 生理状态系统（ASA）评分≥3、严重 OSA、精神疾病、哮喘、腹部手术史、酒精、心脏病和血脂异常后，均与 SPC 风险相关。基于这些因素构建了"OS-SEV90 评分"，以将患者分为 3 个风险组：低危（≤2）、中危（3-4）和高危（≥5）。根据"OS-SEV90 评分"，低危组 SPC 发生率为 2.9%，中危组为 7.7%，高危组为 23.3%，SPC 发生率显著增加。
使用 9 个基线危险因素建立了 90 天内 SPC 的预测模型。使用 OS-SEV90 评分可以帮助多学科团队识别每位患者的具体风险，并在手术前告知他们并优化合并症。需要进一步的研究来验证该评分在新的独立队列中的有效性，然后再将其用于临床实践。
