Vanetta Carolina, Dreifuss Nicolás H, Angeramo Cristian A, Baz Carolina, Cubisino Antonio, Schlottmann Francisco, Masrur Mario A
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
Surg Obes Relat Dis. 2023 Mar;19(3):238-249. doi: 10.1016/j.soard.2022.09.004. Epub 2022 Sep 11.
Length of stay after bariatric surgery has progressively shortened. Same-day discharge (SDD) has been reported for the 2 most common bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to evaluate the safety and success of SDD following SG and RYGB. Systematic literature search on SDD after bariatric surgery was conducted in Medline, Cochrane library, Google Scholar, and Embase. SDD was defined as discharging the patient during the day of the bariatric operation, without an overnight stay. The primary outcomes of interest were successful SDD, readmission, and morbidity rates. The secondary endpoints included reoperation and mortality rates. A proportion meta-analysis was performed to assess the outcomes of interest. A total of 14 studies with 33,403 patients who underwent SDD SG (32,165) or RYGB (1238) were included in the qualitative synthesis. Seven studies with 5000 patients who underwent SDD SG were included in the quantitative analysis, and pooled proportions (PPs) were calculated for the outcomes of interest. The SDD success rate was 63%-100% (PP: 99%) after SG and 88%-98.1% after RYGB. The readmission rate ranged from .6% to 20.8% (PP: 4%) after SDD SG and 2.4%-4% after SDD RYGB. Overall morbidity, reoperation, and mortality were 1.1%-10% (PP:4%), .3%-2.1% (PP: 1%), and 0%-.1% (PP: 0%), respectively, for SDD SG, and 2.5%-4%,1.9%-2.5%, and 0%-.9%, respectively, for SDD RYGB. SDD after SG seems feasible and safe. The outcomes of SDDRYGB seem promising, but the evidenceis stilllimitedto draw definitive conclusions. Selection criteria and perioperative protocolsmust be standardized to adequately introduce this practice.
减肥手术后的住院时间已逐渐缩短。已有报道称，两种最常见的减肥手术——Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）——可实现当日出院（SDD）。本研究旨在评估SG和RYGB术后SDD的安全性和成功率。我们在Medline、Cochrane图书馆、谷歌学术和Embase上对减肥手术后的SDD进行了系统的文献检索。SDD定义为在减肥手术当天让患者出院，无需过夜住院。主要关注的结果是成功的SDD、再入院率和发病率。次要终点包括再次手术率和死亡率。进行了比例荟萃分析以评估关注的结果。定性综合分析纳入了14项研究，共33403例接受SDD SG（32165例）或RYGB（1238例）的患者。定量分析纳入了7项共5000例接受SDD SG的患者的研究，并计算了关注结果的合并比例（PPs）。SG术后SDD成功率为63% - 100%（PP：99%），RYGB术后为88% - 98.1%。SDD SG后的再入院率为0.6%至20.8%（PP：4%），SDD RYGB后为2.4% - 4%。SDD SG的总体发病率、再次手术率和死亡率分别为1.1% - 10%（PP：4%）、0.3% - 2.1%（PP：1%）和0% - 0.1%（PP：0%），SDD RYGB的相应数据分别为2.5% - 4%、1.9% - 2.5%和0% - 0.9%。SG术后的SDD似乎可行且安全。SDD RYGB的结果似乎很有前景，但证据仍然有限，无法得出明确结论。必须对选择标准和围手术期方案进行标准化，以便充分引入这种做法。
