比较 2015 年至 2019 年 MBSAQIP 报告的原发性和翻修腹腔镜袖状胃切除术、胃旁路术和十二指肠转流术的术后早期并发症。
Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019.
机构信息
Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.
Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Surg Endosc. 2023 May;37(5):3728-3738. doi: 10.1007/s00464-022-09796-5. Epub 2023 Jan 18.
BACKGROUND
Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts.
METHODS
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities.
RESULTS
Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]).
CONCLUSIONS
Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.
背景
袖状胃切除术（SG）现在是最常进行的减重手术，但胃旁路术（GB）和十二指肠转位术（DS）仍然很常见，尤其是作为转换/修正（C/R）手术。本分析比较了原发性和 C/R 腹腔镜 SG 与 DS 和 GB 的术后早期结果；以及每种原发性手术与 C/R 对应手术的比较。
方法
从 2015 年到 2019 年，代谢和减重外科认证和质量改进计划（MBSAQIP）数据库查询了 SG、GB 和 DS 病例。多变量逻辑回归计算了 30 天时手术部位感染（SSI）、再次手术和再入院的粗比值比（OR）和调整比值比（aOR），在两个初始比较中：（1）原发性 SG 与 DS 或 GB，（2）C/R SG 与 DS 或 GB。二次分析比较了原发性 GS、GB 或 DS 与 C/R 对应手术。模型调整了混杂的人口统计学和合并症。
结果
在 755968 例原发性病例中，大多数为 SG（72.8%），其次是 GB（26.3%），然后是 DS（0.9%）。与 SG 相比，GB 和 DS 显示 SSI（aOR 3.02 [2.84, 3.2]）、再入院（aOR 1.97 [1.92, 2.03]）和再次手术（aOR 2.74 [2.62, 2.86]）的可能性更高。在 68716 例 C/R 病例中，SG 最为常见（43.2%），其次是 GB（37.5%），然后是 DS（19.2%）。C/R 的 GB 和 DS 显示 SSI（aOR 2.28 [1.98, 2.62]）、再入院（aOR 2.10 [1.94, 2.27]）和再次手术（aOR 2.3 [2.04, 2.59]）的风险更高，分别为 SG。C/R 的 SG 和 DS 显示 SSI（OR 2.09 [1.66, 2.63]；1.63 [1.24, 2.14]）、再入院（OR 1.13 [1.02, 1.26]）和再次手术（OR 1.27 [1.06, 1.52]；1.58 [1.24, 2.0]）的风险高于原发性手术。C/R DS 显示 SSI（OR 1.23 [1.66, 2.63]）的风险更高。
结论
GB 和 DS 的早期并发症与 SG 相比是可比的，而且比 SG 更严重。在 C/R 手术中，GB 和 DS 比 SG 显示出更大的风险。总体而言，C/R 手术显示出大多数但不是所有早期术后并发症的更高风险。
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