Sebastian Raul, Zevallos Alba, Cornejo Jorge, Sarmiento Joaquin, Li Christina, Schweitzer Michael, Adrales Gina L
Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Surg Endosc. 2024 Dec;38(12):7195-7201. doi: 10.1007/s00464-024-11284-x. Epub 2024 Oct 4.
Minimally invasive bariatric surgeries provide effective weight loss with fewer complications. However, postoperative bleeding remains a significant concern due to its potential for serious morbidity and mortality. This study aimed to identify factors predicting postoperative bleeding following laparoscopic and robotic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
We analyzed patients who underwent SG and RYGB using the MBSAQIP database from 2015 to 2021. Four multivariate logistic regression analyses were conducted to investigate the relationship between postoperative bleeding and 24 independent factors for laparoscopic SG (lapSG), robotic SG (rSG), laparoscopic RYGB (lapRYGB), and robotic RYGB (rRYGB).
We analyzed 659,294 lapSG, 53,548 rSG, 267,171 lapRYGB, and 22,492 rRYGB patients. In lapSG, the most significant factors included anticoagulation (OR 3.76; 95% CI 3.13-4.51), renal insufficiency (OR 2.06; 95% CI 1.37-3.09), history of DVT (OR 1.87; 95% CI 1.23-2.85), history of PE (OR 1.69; 95% CI 1.04-2.76, and BMI ≤ 40 (OR 1.22; 95% CI 1.09-1.38). In the rSG group, anticoagulation (OR 4.95; 95% CI 2.83-8.66), COPD (OR 2.80; 95% CI 1.29-6.05), and hyperlipidemia (OR 1.90; 95% CI 1.29-6.05) were significant factors. In lapRYGB, the most significant factors included anticoagulation (OR 3.68; 95% CI 3.11-4.35), renal insufficiency (OR 1.60; 95% CI 1.04-2.44), history of DVT (OR 1.70; 95% CI 1.09-2.07), cardiac stent (OR 1.51; 95% CI 1.09-2.07), and BMI ≤ 40 (OR 1.16; 95% CI 1.03-1.29). For rRYGB, anticoagulation (OR 4.69; 95% CI 2.86-7.70), history of PE (OR 4.28; 95% CI 1.53-12.00), and cardiac stent (OR 2.15; 95% CI 0.06-4.34) were significant.
Preoperative anticoagulation, renal insufficiency, history of DVT and PE, a cardiac stent, and BMI ≤ 40 are associated with an increased risk of postoperative bleeding. The predictive factors were consistent across laparoscopic and robotic approaches in SG and RYGB procedures.
微创减重手术能有效减重且并发症较少。然而，术后出血因其可能导致严重的发病率和死亡率，仍然是一个重大问题。本研究旨在确定预测腹腔镜和机器人袖状胃切除术（SG）及 Roux-en-Y 胃旁路术（RYGB）术后出血的因素。
我们使用 2015 年至 2021 年的 MBSAQIP 数据库分析了接受 SG 和 RYGB 的患者。进行了四项多因素逻辑回归分析，以研究术后出血与腹腔镜 SG（lapSG）、机器人 SG（rSG）、腹腔镜 RYGB（lapRYGB）和机器人 RYGB（rRYGB）的 24 个独立因素之间的关系。
我们分析了 659,294 例 lapSG 患者、53,548 例 rSG 患者、267,171 例 lapRYGB 患者和 22,492 例 rRYGB 患者。在 lapSG 中，最显著的因素包括抗凝（OR 3.76；95%CI 3.13 - 4.51）、肾功能不全（OR 2.06；95%CI 1.37 - 3.09）、深静脉血栓形成病史（OR 1.87；95%CI 1.23 - 2.85）、肺栓塞病史（OR 1.69；95%CI 1.04 - 2.76）以及体重指数≤40（OR 1.22；95%CI 1.09 - 1.38）。在 rSG 组中，抗凝（OR 4.95；95%CI 2.83 - 8.66）、慢性阻塞性肺疾病（OR 2.80；95%CI 1.29 - 6.05）和高脂血症（OR 1.90；95%CI 1.29 - 6.05）是显著因素。在 lapRYGB 中，最显著的因素包括抗凝（OR 3.68；95%CI 3.11 - 4.35）、肾功能不全（OR 1.60；95%CI 1.04 - 2.44）、深静脉血栓形成病史（OR 1.70；95%CI 1.09 - 2.07）、心脏支架（OR 1.51；95%CI 1.09 - 2.07）以及体重指数≤40（OR 1.16；95%CI 1.03 - 1.29）。对于 rRYGB，抗凝（OR 4.69；95%CI 2.86 - 7.70）、肺栓塞病史（OR 4.28；95%CI 1.53 - 12.00）和心脏支架（OR 2.15；95%CI 0.06 - 4.34）是显著因素。
术前抗凝、肾功能不全、深静脉血栓形成和肺栓塞病史、心脏支架以及体重指数≤40与术后出血风险增加相关。在 SG 和 RYGB 手术中，腹腔镜和机器人手术方式的预测因素是一致的。
