Ali Konmal, Cho Nam Yong, Vadlakonda Amulya, Sakowitz Sara, Kim Shineui, Chervu Nikhil, Hadaya Joseph, Benharash Peyman
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Surg Open Sci. 2024 Feb 23;18:85-90. doi: 10.1016/j.sopen.2024.02.011. eCollection 2024 Mar.
Small bowel obstruction (SBO) is a complication of bariatric surgery. However, outcomes of surgical intervention for SBO among patients with prior bariatric surgery remain ill-defined. We used a nationally representative cohort to characterize the outcomes of the SBO management approach in patients with a prior bariatric operation.
All adult hospitalizations for SBO were tabulated from the 2018-2020 National Readmissions Database. Patients with a prior history of bariatric surgery comprised the Bariatric cohort (others: Non-Bariatric). Multivariable models were subsequently developed to evaluate the association of prior bariatric surgery with outcomes of interest.
Of an estimated 299,983 hospitalizations for SBO, 15,788 (5.3 %) had a history of prior bariatric surgery. Compared to Non-Bariatric, Bariatric patients were younger (54 [46-62] vs 57 [47-64] years, < 0.001) and were more frequently privately insured (45.1 vs 39.4 %, < 0.001). On average, the Bariatric more frequently underwent operative management, relative to Non-Bariatric (44.8 vs 29.7 %, < 0.001). Following risk adjustment, among those surgically managed, Bariatric demonstrated lower odds of mortality (Adjusted Odds Ratio [AOR] 0.69, 95 % Confidence Interval [CI] 0.55-0.87) compared to Non-Bariatric. Bariatric also demonstrated lower odds of infectious and renal complications. Furthermore, the Bariatric cohort had lower costs, length of stay, and non-home discharge.
Patients with prior bariatric surgery demonstrated a lower likelihood of mortality, decreased complications, and reduced resource utilization, relative to others. As the incidence of bariatric surgery continues to rise, future work is needed to minimize the incidence of SBO among these patients, especially in the current era of value-based healthcare.
小肠梗阻（SBO）是减肥手术的一种并发症。然而，既往接受过减肥手术的患者中，针对SBO的手术干预结果仍不明确。我们使用了一个具有全国代表性的队列来描述既往接受过减肥手术的患者中SBO管理方法的结果。
从2018 - 2020年全国再入院数据库中列出所有因SBO住院的成年患者。有减肥手术既往史的患者组成减肥队列（其他：非减肥队列）。随后建立多变量模型来评估既往减肥手术与感兴趣的结果之间的关联。
在估计的299,983例因SBO住院的患者中，15,788例（5.3%）有减肥手术既往史。与非减肥队列相比，减肥队列患者更年轻（54 [46 - 62]岁对57 [47 - 64]岁，<0.001），且私人保险覆盖的比例更高（45.1%对39.4%，<0.001）。平均而言，与非减肥队列相比，减肥队列患者接受手术治疗的频率更高（44.8%对29.7%，<0.001）。经过风险调整后，在接受手术治疗的患者中，减肥队列患者的死亡几率低于非减肥队列（调整后优势比[AOR] 0.69，95%置信区间[CI] 0.55 - 0.87）。减肥队列患者发生感染和肾脏并发症的几率也较低。此外，减肥队列的费用、住院时间和非回家出院的比例更低。
与其他患者相比，既往接受过减肥手术的患者死亡可能性更低、并发症减少且资源利用降低。随着减肥手术的发病率持续上升，未来需要开展工作以尽量降低这些患者中SBO的发病率，尤其是在当前基于价值的医疗时代。
