Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands.
Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands.
Surg Obes Relat Dis. 2022 Aug;18(8):1057-1065. doi: 10.1016/j.soard.2022.05.010. Epub 2022 May 18.
Postoperative bleeding remains a relatively common complication following bariatric surgery and may lead to morbidity and even mortality.
To develop a prediction model to identify patients at risk for postoperative bleeding.
Rode Kruis Ziekenhuis, Beverwijk, the Netherlands. Based on Dutch nationwide obesity audit data.
Patients undergoing primary bariatric surgery were selected from January 2015 to December 2020 from the Dutch Audit for Treatment of Obesity. The primary outcome was postoperative bleeding within 30 days. Assessed predictors included patient factors and operative data. A prediction model was developed using backward stepwise logistic regression. Internal validation was performed using bootstrapping techniques.
A total of 59,055 patients were included; 13,399 underwent a sleeve gastrectomy, and 45,656 underwent a gastric bypass procedure. Postoperative bleeding occurred in 1.5%. The following predictors were identified: male patients (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.21-1.63), patients >45 years of age (OR = 1.50; 95% CI: 1.29-1.76), body mass index <40 kg/m (OR = 1.22; 95% CI: 1.06-1.41), cardiovascular disease (OR = 1.36; 95% CI: 1.17-1.57), and sleeve gastrectomy (OR = 1.43; 95% CI: 1.24-1.67). Area under the curve for the model was .612. Following bootstrapping for internal validation, a correction of .9817 was applied.
A clinical decision rule was designed to assess the risk of postoperative bleeding in patients undergoing bariatric surgery. If 3 or more risk factors are present, there is an increased risk for postoperative bleeding. The model can aid in clinical decision-making: implementing extra preventative measures in high-risk patients. External validation is needed to further develop the model.
术后出血仍然是肥胖症手术后较为常见的并发症之一，可能导致发病率甚至死亡率。
开发一种预测模型以识别术后出血风险患者。
荷兰贝弗韦克 Rode Kruis 医院，基于荷兰全国肥胖症审计数据。
从 2015 年 1 月至 2020 年 12 月，从荷兰肥胖症治疗审计中选择接受原发性减肥手术的患者。主要结局是术后 30 天内出血。评估的预测因素包括患者因素和手术数据。使用向后逐步逻辑回归法开发预测模型。使用自举技术进行内部验证。
共纳入 59055 例患者；13399 例行胃袖状切除术，45656 例行胃旁路手术。术后出血发生率为 1.5%。确定了以下预测因素：男性患者（比值比[OR] = 1.40；95%置信区间[CI]：1.21-1.63）、年龄>45 岁（OR = 1.50；95% CI：1.29-1.76）、体重指数<40 kg/m（OR = 1.22；95% CI：1.06-1.41）、心血管疾病（OR = 1.36；95% CI：1.17-1.57）和胃袖状切除术（OR = 1.43；95% CI：1.24-1.67）。该模型的曲线下面积为 0.612。进行内部验证的自举后，应用校正值 0.9817。
设计了一个临床决策规则来评估接受减肥手术的患者术后出血的风险。如果存在 3 个或更多危险因素，则术后出血风险增加。该模型可以辅助临床决策：在高危患者中实施额外的预防措施。需要进行外部验证以进一步开发该模型。
