Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA.
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Surg Endosc. 2023 Jun;37(6):4113-4122. doi: 10.1007/s00464-023-09927-6. Epub 2023 Feb 8.
The implications of operative time (OT) have been studied in different surgical specialties, showing a correlation with higher incidence rates of postoperative complications. However, the impact of OT on bariatric surgery complications is not well elucidated.
A retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2015 and 2019 was performed. A total of 358,382 SG patients and 123,357 RYGB patients were included. The median OT was 68 min (10-720) and 113 min (10-640) for the sleeve gastrectomy (SG) group and the Roux-en-Y gastric bypass group, respectively. The groups were subdivided into two subgroups based on OT in comparison to the median time of each group. The subgroups were compared for surgical complications and outcomes. To reduce selection bias and risk of confounders, we performed a propensity score matching (PSM) for 22 variables.
In the PSM-matched cohort, 18,915 SG and 6,495 RYGB patients were included in each subgroup. The SG cohort showed higher rates of Clavien-Dindo Class 1, 2, 3a, 4, and 5 complications as well as higher rates of readmission, reoperation, and reintervention in the longer OT group before matching. After PSM, the subgroup with longer times continued to have higher rates of Clavien-Dindo Class 2 complications and higher rates of readmission and reoperation. Similarly, there were higher rates of all Clavien-Dindo class complications as well as readmission, reoperation, and reintervention in the RYGB group with higher OT. After PSM, there were still higher rates of Clavien-Dindo Class 3a complications as well as readmission and reintervention in the RYGB subgroup with prolonged OT.
In both SG and RYGB, longer OT was associated with increased rates of complications as well as readmission, reoperation, and reintervention. Surgeons should be cognizant of the increased rates of complications when operative times are longer.
手术时间（OT）的影响已在不同的外科专业中进行了研究，结果表明其与术后并发症的发生率呈正相关。然而，OT 对减重手术并发症的影响尚不清楚。
对 2015 年至 2019 年期间代谢和减重手术认证和质量改进计划数据库进行了回顾性分析。共纳入 358382 例 SG 患者和 123357 例 RYGB 患者。袖状胃切除术（SG）组的中位 OT 为 68 分钟（10-720），RYGB 组为 113 分钟（10-640）。根据每组的中位数时间，将两组分为两组亚组。比较亚组之间的手术并发症和结果。为了减少选择偏倚和混杂因素的风险，我们对 22 个变量进行了倾向评分匹配（PSM）。
在 PSM 匹配队列中，每组亚组分别纳入 18915 例 SG 和 6495 例 RYGB 患者。在匹配前，SG 组 OT 较长的亚组中，Clavien-Dindo 1 级、2 级、3a 级、4 级和 5 级并发症的发生率以及再入院、再次手术和再次干预的发生率均较高。PSM 后，较长时间的亚组中 Clavien-Dindo 2 级并发症以及再入院和再次手术的发生率仍较高。同样，OT 较长的 RYGB 组中，所有 Clavien-Dindo 级别的并发症以及再入院、再次手术和再次干预的发生率也较高。PSM 后，RYGB 亚组 OT 延长，Clavien-Dindo 3a 级并发症以及再入院和再干预的发生率仍较高。
在 SG 和 RYGB 中，OT 较长与并发症以及再入院、再次手术和再次干预的发生率增加相关。当手术时间较长时，外科医生应意识到并发症发生率增加。
