Golzarand Mahdieh, Toolabi Karamollah, Parsaei Reza
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran.
Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141, Tehran, Iran.
Obes Surg. 2022 Jul;32(7):1-8. doi: 10.1007/s11695-022-06059-z. Epub 2022 Apr 26.
Identifying the possible predictors of postoperative bleeding is advantageous to reduce healthcare costs and promote patients' recovery. The aim of this study was to determine early postoperative bleeding predictors after bariatric surgery.
This retrospective study was conducted using data from 2260 patients who underwent bariatric surgery. We diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased hemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48 h after surgery.
Our results showed the odds of early postoperative bleeding in laparoscopic Roux-en-Y gastric bypass (LRYGB) were higher than in laparoscopic sleeve gastrectomy (LSG) (OR 3.49, 95% CI 1.79 to 6.80). In addition, prior intragastric balloon (IGB) (OR 3.14, 95% CI 1.18 to 8.34) and oral non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) (OR 5.91, 95% CI 1.79 to 20.63) were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative bleeding (OR 0.18, 95% CI 0.04 to 0.81). After stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event.
Our results demonstrated a positive association between type of procedure, history of IGB, and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery.
确定术后出血的可能预测因素有利于降低医疗成本并促进患者康复。本研究的目的是确定减肥手术后早期术后出血的预测因素。
本回顾性研究使用了2260例行减肥手术患者的数据。我们通过以下症状诊断早期术后出血：腹痛、低血压、心动过速、呕血、黑便、血红蛋白水平降低、术后48小时内至少需要输注两个单位的浓缩红细胞以及再次手术。
我们的结果显示，腹腔镜Roux-en-Y胃旁路术（LRYGB）术后早期出血的几率高于腹腔镜袖状胃切除术（LSG）（比值比3.49，95%置信区间1.79至6.80）。此外，既往胃内球囊（IGB）治疗史（比值比3.14，95%置信区间1.18至8.34）和口服非阿司匹林非甾体抗炎药（NSAIDs）（比值比5.91，95%置信区间1.79至20.63）与术后出血的发生呈正相关。相比之下，吻合钉线加固缝合与术后出血几率呈负相关（比值比0.18，95%置信区间0.04至0.81）。根据手术类型对数据进行分层后，IGB与出血几率之间的正相关在LRYGB组中保持不变。在LSG组中，使用非阿司匹林NSAIDs与术后出血发生率较高相关，而吻合钉线加固缝合降低了该事件的发生率。
我们的结果表明，手术类型、IGB治疗史和口服非阿司匹林NSIADs的使用之间存在正相关，以及吻合钉线加固缝合与减肥手术后出血几率之间存在负相关。
