Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
Surg Endosc. 2023 Oct;37(10):7437-7443. doi: 10.1007/s00464-023-10201-y. Epub 2023 Jul 3.
The timing of bleeding after bariatric surgery and subsequent management (characterized as surgical versus non-surgical (i.e., interventions including endoscopic or interventional radiology approaches)) has not been thoroughly studied. As such, we sought to describe the rates of reoperation or non-operative intervention after bleeding following sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).
The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database was queried between 2015 and 2018 for any bleeding after SG or RYGB and subsequent reoperation or non-operative intervention. Multivariable Fine-Gray models were used to compare the hazard of reoperation/non-operative intervention. Multivariable generalized linear regression models were used to test the number of subsequent reoperations/non-operative interventions depending on initial management.
6251 patients with bleeding after SG or RYGB were identified, of which 2653 patients underwent subsequent procedures (n = 1375 [51.83%] RYGB index procedure, n = 1278 [48.17%] SG index procedure). 1892 (71.32%) and 761 (28.68%) patients had reoperation and non-operative intervention, respectively. For patients who developed bleeding, SG was associated with significantly higher reoperation risk, while RYGB was associated with significantly higher risk of non-operative intervention. Early bleeding was associated with significantly increased risk of reoperation and decreased risk of non-operative intervention, regardless of initial procedure. The total number of subsequent reoperations/non-operative interventions did not differ significantly depending on whether the patients had non-operative intervention or reoperation first [ratio 1.01, 95% CI (0.75, 1.36), p value 0.9418].
Patients after SG who experience bleeding are more likely to undergo reoperation than RYGB patients. On the other hand, patients with bleeding after RYGB are more likely to undergo non-operative intervention compared to SG patients. Early bleeding is associated with higher risk of reoperation and lower risk of non-operative intervention both after SG and RYGB. The initial approach did not play a role in the total number of subsequent reoperations/non-operative interventions.
减重手术后出血及其后续管理（特征为手术与非手术（即包括内镜或介入放射学方法的干预））的时间尚未得到充分研究。因此，我们旨在描述胃袖状切除术（SG）或 Roux-en-Y 胃旁路术（RYGB）后出血后的再手术或非手术干预的发生率。
2015 年至 2018 年，代谢和减重外科认证和质量改进计划（MBSAQIP）数据库对 SG 或 RYGB 后出血及随后的再手术或非手术干预进行了查询。多变量 Fine-Gray 模型用于比较再手术/非手术干预的风险。多变量广义线性回归模型用于根据初始治疗检验后续再手术/非手术干预的数量。
确定了 6251 例 SG 或 RYGB 后出血的患者，其中 2653 例患者接受了后续手术（n=1375 [51.83%] RYGB 指数手术，n=1278 [48.17%] SG 指数手术）。1892（71.32%）和 761（28.68%）例患者接受了再手术和非手术干预。对于发生出血的患者，SG 与再手术风险显著增加相关，而 RYGB 与非手术干预风险显著增加相关。无论初始手术如何，早期出血与再手术风险显著增加和非手术干预风险显著降低相关。随后再手术/非手术干预的总次数与患者是否先进行非手术干预或再手术无关[比值 1.01，95%CI（0.75，1.36），p 值 0.9418]。
SG 后发生出血的患者比 RYGB 患者更有可能接受再手术。另一方面，与 SG 患者相比，RYGB 后出血的患者更有可能接受非手术干预。早期出血与 SG 和 RYGB 后再手术风险增加和非手术干预风险降低相关。初始方法在随后再手术/非手术干预的总次数中不起作用。
