Dirks Rebecca C, Athanasiadis Dimitrios I, Hilgendorf William A, Ziegler Kathryn M, Waldrop Caitlyn, Embry Marisa, Selzer Don J
Department of Surgery, University School of Medicine, Indiana, USA.
Indiana University Health North Hospital, Indianapolis, IN, USA.
Surg Endosc. 2022 Apr;36(4):2591-2599. doi: 10.1007/s00464-021-08549-0. Epub 2021 May 13.
Standards for preoperative bariatric patient selection include a thorough psychological evaluation. Using patients "red-flagged" during preoperative evaluations, this study aims to identify trends in long-term follow-up and complications to further optimize bariatric patient selection.
A multidisciplinary team held a case review conference (CRC) to discuss red-flagged patients. A retrospective chart review compared CRC patients to control patients who underwent bariatric surgery in the same interval. Patients under 18 years old, undergoing revisional bariatric surgery, or getting band placement were excluded. High-risk characteristics causing CRC inclusion, preoperative demographics, percent follow-up and other postoperative outcomes were collected up to 5 years postoperatively. If univariate analysis revealed a significant difference between cohorts, multivariable analysis was performed.
Two hundred and fifty three patients were red-flagged from 2012 to 2013, of which 79 underwent surgery. After excluding 21 revisions, 3 non-adult patients, and 6 band patients, 55 red-flagged patients were analyzed in addition to 273 control patients. Patient age, sex, initial BMI, ASA, and co-morbidities were similar between groups, though flagged patients underwent RYGB more frequently than control patients. Notably, percent excess BMI loss and percent follow-up (6 months-5 years) were similar. In multivariable analysis, minor complications were more common in flagged patients; and marginal ulcers, endoscopy, and dilation for stenosis were more common in flagged versus control patients who underwent RYGB. Perforation, reoperation, revision, incisional hernia, and internal hernia were statistically similar in both groups, though reoperation was significantly more common in patients with multiple reasons to be flagged compared to controls.
Bariatric patients deemed high risk for various psychosocial issues have similar follow-up, BMI loss, and major complications compared to controls. High-risk RYGB patients have greater minor complications, warranting additional counseling of high-risk patients.
肥胖症患者术前选择标准包括全面的心理评估。本研究利用术前评估期间被“标记”的患者，旨在确定长期随访和并发症的趋势，以进一步优化肥胖症患者的选择。
一个多学科团队召开了病例审查会议（CRC），以讨论被标记的患者。一项回顾性图表审查将CRC患者与同期接受减肥手术的对照患者进行了比较。排除了18岁以下、接受减肥手术翻修或接受束带置入的患者。收集术后长达5年的导致CRC纳入的高危特征、术前人口统计学数据、随访百分比和其他术后结果。如果单变量分析显示队列之间存在显著差异，则进行多变量分析。
2012年至2013年有253例患者被标记，其中79例接受了手术。在排除21例翻修手术患者、3例非成年患者和6例束带患者后，除273例对照患者外，还对55例被标记患者进行了分析。两组患者的年龄、性别、初始BMI、ASA和合并症相似，不过被标记患者比对照患者更频繁地接受RYGB手术。值得注意的是，超重BMI损失百分比和随访百分比（6个月至5年）相似。在多变量分析中，被标记患者的轻微并发症更常见；接受RYGB手术的被标记患者与对照患者相比，边缘溃疡、内镜检查和狭窄扩张更常见。两组的穿孔、再次手术、翻修、切口疝和内疝在统计学上相似，不过与对照组相比，因多种原因被标记的患者再次手术明显更常见。
与对照组相比，因各种心理社会问题被视为高危的肥胖症患者在随访、BMI降低和主要并发症方面相似。高危RYGB患者有更多的轻微并发症，需要对高危患者进行额外的咨询。
