Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana.
Surg Obes Relat Dis. 2024 Dec;20(12):1216-1224. doi: 10.1016/j.soard.2024.07.005. Epub 2024 Jul 20.
Early small bowel obstruction (eSBO) (within 30-days) is a rare but important complication that is associated with high rates of morbidity, including readmission, reintervention, and reoperation.
To identify patient-specific and operation-specific characteristics that predispose patients to eSBO and to identify at-risk individuals preoperatively.
2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Utilizing the 2015-2021 MBSAQIP PUF, 1,016,484 records were analyzed. Pediatric, revisional, open-conversion, and cases with incomplete data in sex, body mass index, operative-time, 30-day-follow-up variables were excluded. Case details were compared using Fisher's exact & Wilcoxon -Mann -Whitney tests to identify at-risk patients. The likelihood of eSBO was modeled with rare event logistic regression.
Incidence of eSBO was .40%. Of the 4103 occurrences of eSBO, RYGB (Roux-en-Y gastric bypass), SG (sleeve gastrectomy), and DS (duodenal switch) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO. History of prior foregut surgery, a non-metabolic surgery trained operator, and longer operative times were all associated with increased eSBO (P < .0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, P < .0001) and RYGB (OR 5.18, P < .0001) compared to SG. Increased length of operation (OR 1.03, P < .0001) and non -MS-trained operators (OR 1.33, P < .0001) remained highly significant. Male-sex (OR .70, P < .0001) and diabetes (OR .78, P < .0001) were both protective.
In the largest analysis to date, eSBO remains a rare event. RYGB accounts for the largest proportion of eSBO, however, DS has a higher risk adjusted rate of eSBO.
早期小肠梗阻（eSBO）（30 天内）是一种罕见但重要的并发症，与高发病率相关，包括再次入院、再次干预和再次手术。
确定使患者易患 eSBO 的患者特异性和手术特异性特征，并在术前识别高危个体。
2015-2021 年代谢和减肥手术认证和质量改进计划（MBSAQIP）。
利用 2015-2021 年 MBSAQIP PUF，分析了 1016484 份记录。排除儿科、翻修、开放式转换以及性别、体重指数、手术时间、30 天随访变量数据不完整的病例。使用 Fisher 精确检验和 Wilcoxon -Mann -Whitney 检验比较病例细节，以确定高危患者。使用罕见事件逻辑回归模型来预测 eSBO 的可能性。
eSBO 的发生率为 0.40%。在 4103 例 eSBO 中，RYGB（Roux-en-Y 胃旁路术）、SG（袖状胃切除术）和 DS（十二指肠转位术）分别占 79.4%、19.3%和 1.3%。许多患者特异性特征与 eSBO 显著相关。上消化道手术史、非代谢手术培训医生和较长的手术时间均与 eSBO 增加相关（P <.0001）。同时控制这些因素，DS（比值比 9.55，P <.0001）和 RYGB（比值比 5.18，P <.0001）的 eSBO 仍然高于 SG。手术时间延长（比值比 1.03，P <.0001）和非 MS 培训医生（比值比 1.33，P <.0001）仍然高度显著。男性（比值比.70，P <.0001）和糖尿病（比值比.78，P <.0001）均具有保护作用。
在迄今为止最大的分析中，eSBO 仍然是一种罕见的事件。RYGB 占 eSBO 的最大比例，但 DS 的风险调整后 eSBO 发生率更高。
