同日腹腔镜Roux-en-Y胃旁路手术的结局比较：一项利用MBSAQIP PUF进行倾向评分匹配分析
Outcomes comparison for same-day laparoscopic Roux-en-Y gastric bypass: a propensity score matched analysis utilizing the MBSAQIP PUF.
作者信息
Perez Samuel C, Arefanian Saeed, Landrenaeu Joshua, Wheeler Andrew A
机构信息
Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
出版信息
Surg Endosc. 2025 Jun 27. doi: 10.1007/s00464-025-11941-9.
BACKGROUND
Patients undergoing gastric bypass are typically admitted overnight, however same-day discharge after Roux-en-Y Gastric Bypass (SDD-RYGB) procedure may lead to improved patient throughput and satisfaction. The safety profile of this approach has not been well studied. Therefore, we aimed to determine the perioperative and 30-day outcomes in patients undergoing SDD-RYGB compared to patients who required an overnight admission.
METHODS
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used for years 2015-2022. Propensity score matching (PSM) was conducted using clinically and statistically significant preoperative characteristics to create two patient groups (SDD-RYGB and overnight admission). Postoperative outcomes were analyzed.
RESULTS
A total of 4845 patients underwent SDD-RYGB. PSM yielded 4843 patient pairs. PSM sensitivity analysis was completed and demonstrated adequate matching between both groups. After PSM, patients undergoing the SDD-RYGB had an acceptable 30-day postoperative complication rate as compared to those with an overnight admission. Patients who had an overnight admission did have an increased rate of concurrent adhesiolysis during their RYGB procedure (3.92% vs 2.89%; p = 0.006). SDD-RYGB patients experienced a lower rate of postoperative intervention (0.89% vs 1.36%; p = 0.035), with similar rates of readmission (3.74% vs 4.10%; p = 0.425), re-operation (1.24% vs 0.93%; p = 0.172), and death (0.19% vs 0.08%; p = 0.267). Patients also experienced equal rates of postoperative bleeding (0.56% vs 0.39%; p = 0.302) and postoperative leak (0.19% vs 0.25%; p = 0.663). Patients undergoing SDD-RYGB were more likely to require postoperative outpatient dehydration treatment (5.66% vs 3.86%; p < 0.001).
CONCLUSIONS
SDD-RYGB is generating continued interest and in appropriately selected patients has similar rates of major morbidity compared to those who are admitted overnight for 1-2 days. SDD-RYGB may have the potential to reduce hospital burden and cost while providing patients with a safe operation and expeditious recovery.
背景
接受胃旁路手术的患者通常需要住院过夜，然而， Roux-en-Y胃旁路手术（SDD-RYGB）后当日出院可能会提高患者周转率和满意度。这种方法的安全性尚未得到充分研究。因此，我们旨在确定与需要住院过夜的患者相比，接受SDD-RYGB手术患者的围手术期和30天结局。
方法
使用代谢与减重手术认证及质量改进计划（MBSAQIP）数据库，数据来源于2015年至2022年。采用倾向评分匹配（PSM）方法，根据临床和统计学上有意义的术前特征创建两个患者组（SDD-RYGB组和住院过夜组）。对术后结局进行分析。
结果
共有4845例患者接受了SDD-RYGB手术。PSM产生了4843对患者。完成了PSM敏感性分析，结果表明两组之间匹配良好。PSM后，与住院过夜的患者相比，接受SDD-RYGB手术的患者术后30天并发症发生率可接受。住院过夜的患者在其RYGB手术期间进行粘连松解术的发生率较高（3.92%对2.89%；p = 0.006）。SDD-RYGB组患者术后干预率较低（0.89%对1.36%；p = 0.035），再入院率（3.74%对4.10%；p = 0.425）、再次手术率（1.24%对0.93%；p = 0.172）和死亡率（0.19%对0.08%；p = 0.267）相似。患者术后出血率（0.56%对0.39%；p = 0.302）和术后渗漏率（0.19%对0.25%；p = 0.663）也相同。接受SDD-RYGB手术的患者更有可能需要术后门诊脱水治疗（5.66%对3.86%；p < 0.001）。
结论
SDD-RYGB越来越受到关注，在适当选择的患者中，与住院1-2天过夜的患者相比，其主要发病率相似。SDD-RYGB可能有潜力减轻医院负担和成本，同时为患者提供安全的手术和快速康复。
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