Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Am J Emerg Med. 2024 Jul;81:82-85. doi: 10.1016/j.ajem.2024.04.033. Epub 2024 Apr 21.
Bariatric surgery is becoming increasingly common and postoperative patients often present to the emergency department (ED) with complications. We sought to describe the presenting complaints, management, and outcomes of postoperative bariatric surgery patients seen in the ED.
We conducted a health records review of 300 consecutive postoperative Roux-en-Y bypass surgery patients who presented to two tertiary care EDs of a major bariatric surgery center within one year of surgery. Cases were identified using a data analytic tool, and two evaluators abstracted clinical variables, imaging, treatments, and outcomes using the electronic health record. Attending emergency physicians verified the data and an experienced bariatric surgeon interpreted the computed tomography (CT) results and surgical procedures.
We included 300 patients with mean age 43.0 years, 89.7% female. Of these, 70.0% presented within 30 days of surgery and 41.7% were admitted to hospital. ED treatments included intravenous fluids (67.0%), antiemetics (53.3%), and analgesia (61.9%). Patients presenting within 30 days of surgery were more likely to undergo a CT (74.3% vs 63.3%; p = 0.06) and to have clinically important CT findings (31.9% vs 6.6%; p ≤0.001). More of the ≤30-day patients were admitted to hospital (46.2% vs 31.1%; p = 0.02). While a higher proportion of patients presenting after 30 days underwent a procedure, a large number of those were not directly related to bariatric surgery, such as appendectomy and cholecystectomy. Of the 34 patients undergoing a procedure, the majority presented with abdominal pain (76.5%).
This is the first detailed health records review of postoperative bariatric patients seen in the ED in the emergency medicine literature. Those presenting with abdominal pain were more likely to undergo CT abdomen and a surgical procedure. Similarly, those presenting within 30 days of surgery were more likely to have significant CT findings and require hospital admission. Others presenting with primarily nausea and vomiting may improve with ED symptom management and be discharged home with bariatric team follow-up.
减重手术越来越普遍，术后患者常因并发症到急诊科就诊。我们旨在描述在急诊科接受治疗的术后减重手术患者的就诊主诉、治疗方法和结局。
我们对在术后一年内到一家主要减重手术中心的两家三级护理急诊科就诊的 300 例连续接受 Roux-en-Y 旁路手术后的患者进行了病历回顾。使用数据分析工具确定病例，并由两名评估者使用电子病历提取临床变量、影像学检查、治疗和结局。主治急诊医生对数据进行了验证，一位经验丰富的减重外科医生对计算机断层扫描（CT）结果和手术过程进行了解读。
我们纳入了 300 例患者，平均年龄为 43.0 岁，89.7%为女性。其中，70.0%的患者在术后 30 天内就诊，41.7%的患者住院。急诊科的治疗方法包括静脉补液（67.0%）、止吐药（53.3%）和镇痛药（61.9%）。术后 30 天内就诊的患者更有可能进行 CT 检查（74.3%比 63.3%；p=0.06），也更有可能出现有临床意义的 CT 结果（31.9%比 6.6%；p≤0.001）。术后 30 天内就诊的患者中更多的患者住院（46.2%比 31.1%；p=0.02）。尽管更多术后 30 天就诊的患者接受了手术，但其中许多手术与减重手术无关，例如阑尾切除术和胆囊切除术。在 34 例接受手术的患者中，大多数患者表现为腹痛（76.5%）。
这是第一篇在急诊医学文献中详细描述急诊科接受减重手术治疗的患者的病历回顾。以腹痛为主要表现的患者更有可能进行腹部 CT 检查和手术。同样，术后 30 天内就诊的患者更有可能出现明显的 CT 结果，需要住院治疗。主要表现为恶心和呕吐的患者可能通过急诊科的症状管理而有所改善，出院后由减重手术团队进行随访。
