Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Surg Obes Relat Dis. 2024 Aug;20(8):767-773. doi: 10.1016/j.soard.2024.02.005. Epub 2024 Feb 28.
It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after bariatric surgery.
To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.
MBSAQIP-accredited hospitals in the United States and Canada.
We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson-Aalen estimator was used to determine the cumulative hazards of leak.
In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, P = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, P = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).
Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.
目前尚不清楚在上腹部手术后的即刻期进行常规上消化道吞咽研究（SS）是否与减重手术后胃肠道漏的早期诊断有关。
调查常规 SS 与术后胃肠道漏诊断时间之间的关系。
美国和加拿大的 MBSAQIP 认证医院。
我们对 2015 年至 2019 年 MBSAQIP 数据库中接受腹腔镜下胃旁路术（RYGB）（n = 82510）和袖状胃切除术（SG）（n = 283520）的成年人进行了一项观察性队列研究。使用倾向评分对接受常规 SS 与不接受常规 SS 的患者队列进行匹配。主要结局是漏诊的时间。比较漏诊的中位天数。使用 Nelson-Aalen 估计器确定漏诊的累积危险。
在我们的研究中，36280 例（23%）RYGB 和 135335 例（33%）SG 患者接受了常规 SS。常规 SS 与更早诊断漏诊无关（RYGB 常规 SS 中位数 7 [IQR 3-12] 天比无常规 SS 6 [2-11] 天，P =.9；SG 常规 SS 15 [9-22] 天比无常规 SS 14 [8-21] 天，P =.06）或漏诊风险较低（RYGB HR 1.0，95%-CI.8-1.2；SG HR 1.1，95%-CI 1.0-1.4）。更多的常规 SS 患者住院时间为 2 天或更长时间（RYGB 78.3%比 61.1%；SG 48.6%比 40.3%）。
与无常规 SS 相比，常规 SS 并不能更早诊断漏诊。外科医生应考虑放弃常规 SS 的做法，以尽早诊断术后漏诊。
