Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 112 St. NW, Edmonton, AB, T6G 2B7, Canada.
Surg Endosc. 2023 Jul;37(7):5303-5312. doi: 10.1007/s00464-023-10026-9. Epub 2023 Mar 29.
Patients undergoing bariatric surgery experience substantial risk of pre- and postoperative substance use. Identifying patients at risk for substance use using validated screening tools remains crucial to risk mitigation and operative planning. We aimed to evaluate proportion of bariatric surgery patients undergoing specific substance abuse screening, factors associated with screening and the relationship between screening and postoperative complications.
The 2021 MBSAQIP database was analyzed. Bivariate analysis was performed to compare factors between groups who were screened for substance abuse versus non-screened, and to compare frequency of outcomes. Multivariate logistic regression analysis was performed to assess the independent effect of substance screening on serious complications and mortality, and to assess factors associated with substance abuse screening.
A total of 210, 804 patients were included, with 133,313 (63.2%) undergoing screening and 77,491 (36.8%) who did not. Those who underwent screening were more likely to be white, non-smoker, and have more comorbidities. The frequency of complications was not significant (e.g., reintervention, reoperation, leak) or similar (readmission rates 3.3% vs. 3.5%) between screened and not screened groups. On multivariate analysis, lower substance abuse screening was not associated with 30-day death or 30-day serious complication. Factors that significantly affected likelihood of being screened for substance abuse included being black (aOR 0.87, p < 0.001) or other race (aOR 0.82, p < 0.001) compared to white, being a smoker (aOR 0.93, p < 0.001), having a conversion or revision procedure (aOR 0.78, p < 0.001; aOR 0.64, p < 0.001, respectively), having more comorbidities and undergoing Roux-en-y gastric bypass (aOR 1.13, p < 0.001).
There remains significant inequities in substance abuse screening in bariatric surgery patients regarding demographic, clinical, and operative factors. These factors include race, smoking status, presence of preoperative comorbidities, and procedure type. Further awareness and initiatives highlighting the importance of identifying at risk patients is critical for ongoing outcome improvement.
接受减重手术的患者在术前和术后都有大量物质使用的风险。使用经过验证的筛查工具识别有物质使用风险的患者对于降低风险和手术计划仍然至关重要。我们旨在评估接受特定物质滥用筛查的减重手术患者的比例、与筛查相关的因素以及筛查与术后并发症之间的关系。
分析了 2021 年 MBSAQIP 数据库。进行了双变量分析，以比较接受物质滥用筛查与未接受筛查的患者之间的因素，并比较结局的频率。进行多变量逻辑回归分析，以评估物质筛查对严重并发症和死亡率的独立影响，并评估与物质滥用筛查相关的因素。
共纳入 210831 名患者，其中 133313 名（63.2%）接受了筛查，77491 名（36.8%）未接受筛查。接受筛查的患者更有可能是白人、不吸烟者，且合并症更多。筛查组和未筛查组的并发症频率无显著差异（例如，再次干预、再次手术、漏诊）或相似（再入院率 3.3%比 3.5%）。多变量分析显示，较低的物质滥用筛查与 30 天内死亡或 30 天内严重并发症无关。显著影响物质滥用筛查可能性的因素包括与白人相比为黑人（OR 0.87，p<0.001）或其他种族（OR 0.82，p<0.001）、吸烟（OR 0.93，p<0.001）、转换或修正手术（OR 0.78，p<0.001；OR 0.64，p<0.001，分别）、合并更多并存疾病和行 Roux-en-y 胃旁路术（OR 1.13，p<0.001）。
在接受减重手术的患者中，在人口统计学、临床和手术因素方面，物质滥用筛查仍然存在显著的不平等。这些因素包括种族、吸烟状况、术前合并症的存在以及手术类型。进一步提高对识别高危患者重要性的认识和倡议，对于持续改善结果至关重要。
