腹腔镜 Roux-en-Y 胃旁路术后早期小肠梗阻再入院的风险因素：MBSAQIP 分析。
Risk factors for readmission for early small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: an MBSAQIP analysis.
机构信息
Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Obesity and Metabolic Health, University of California, Los Angeles, California; Center for Advanced Surgical & Interventional Technology, University of California, Los Angeles, California.
Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Center for Advanced Surgical & Interventional Technology, University of California, Los Angeles, California; Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Surg Obes Relat Dis. 2021 Jun;17(6):1041-1048. doi: 10.1016/j.soard.2021.02.031. Epub 2021 Mar 8.
BACKGROUND
Small bowel obstruction (SBO) following laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with significant morbidity.
OBJECTIVES
To evaluate the rate of and risk factors for readmission for SBO within 30 days of LRYGB.
SETTING
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers.
METHODS
This is a retrospective study using the MBSAQIP database. A query was performed from 2015-2018 for patients who underwent LRYGB and required readmission for SBO. Those who had a reoperation, intervention, readmission, or expired from causes other than SBO were excluded. Descriptive, bivariate, and binary logistic regression analyses were performed.
RESULTS
Among 184,660 patients undergoing LRYGB, 1189 (.64%) required readmission due to SBO. Among the readmission cases, 978 (82.5%) were identified as having intestinal obstruction (unspecified), 108 (9.1%) incisional hernia, and 100 (8.4%) internal hernia. Among these cases, 69% had a reoperation and 1.3% expired during the 30-day period. From a logistic regression model, parameters independently associated with an increased risk for readmission for early SBO include being female (adjusted odds ratio [AOR], 1.53) or black (AOR, 1.41) and having gastroesophageal reflux (AOR, 1.35), a history of myocardial infarction (AOR, 1.76), a history of deep vein thrombosis (AOR, 1.73), previous obesity surgery/foregut surgery (AOR, 1.79), a robotic-assisted procedure (AOR, 1.23), concurrent hiatal hernia repair (AOR, 1.66) and adhesiolysis (AOR, 1.42).
CONCLUSION
The rate of readmission for early SBO following LRYGB was less than 1%. The majority of these cases required reoperation. The increased intraoperative complexity of LRYGB is associated with an increased risk of readmission due to early SBO.
背景
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后出现小肠梗阻（SBO）与显著的发病率有关。
目的
评估 LRYGB 后 30 天内 SBO 再入院的发生率和危险因素。
设置
代谢和减肥手术认证和质量改进计划（MBSAQIP）认证中心。
方法
这是一项使用 MBSAQIP 数据库的回顾性研究。从 2015 年至 2018 年，对接受 LRYGB 并因 SBO 再入院的患者进行了查询。排除了需要再次手术、介入、再入院或因 SBO 以外的原因死亡的患者。进行了描述性、双变量和二元逻辑回归分析。
结果
在 184660 例接受 LRYGB 的患者中，有 1189 例（0.64%）因 SBO 再入院。在再入院病例中，978 例（82.5%）被确定为肠梗阻（未特指），108 例（9.1%）切口疝，100 例（8.4%）内疝。在这些病例中，69%进行了再次手术，1.3%在 30 天内死亡。从逻辑回归模型中，与早期 SBO 再入院风险增加相关的参数包括女性（调整优势比 [AOR]，1.53）或黑人（AOR，1.41）和胃食管反流（AOR，1.35）、心肌梗死史（AOR，1.76）、深静脉血栓形成史（AOR，1.73）、既往肥胖手术/前肠手术史（AOR，1.79）、机器人辅助手术（AOR，1.23）、同时行食管裂孔疝修补术（AOR，1.66）和粘连松解术（AOR，1.42）。
结论
LRYGB 后早期 SBO 的再入院率小于 1%。这些病例中的大多数需要再次手术。LRYGB 术中复杂性的增加与早期 SBO 再入院的风险增加有关。
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