Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

被引：13

作者：

Liu, Jason B. ^{[1
,2
]}

Ban, Kristen A. ^{[1
,3
]}

Berian, Julia R. ^{[1
,2
]}

Hutter, Matthew M. ^{[4
]}

Huffman, Kristopher M. ^{[1
]}

Liu, Yaoming ^{[1
]}

Hoyt, David B. ^{[1
]}

Hall, Bruce L. ^{[1
,5
,6
,7
]}

Ko, Clifford Y. ^{[1
,8
]}

机构：

[1] Amer Coll Surg, 633 N St Clair St, Chicago, IL 60611 USA

[2] Univ Chicago Med, Dept Surg, Chicago, IL 60637 USA

[3] Loyola Univ, Med Ctr, Dept Surg, Maywood, IL 60153 USA

[4] Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg, Boston, MA USA

[5] Washington Univ, Dept Surg, St Louis, MO USA

[6] Washington Univ, Olin Business Sch, St Louis, MO USA

[7] BJC Healthcare, St Louis, MO USA

[8] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Los Angeles, CA 90095 USA

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2017年 / 358卷

关键词：

COMPLICATION RATES; PATIENT OUTCOMES; SURGERY; SAFETY; VOLUME;

D O I：

10.1136/bmj.j4244

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA. DESIGN Retrospective, propensity score matched cohort study. SETTING Hospitals in the US accredited by the American College of Surgeons' metabolic and bariatric surgery accreditation and quality improvement program. PARTICIPANTS 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016. MAIN OUTCOME MEASURES The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety. RESULTS In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% v 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84). CONCLUSIONS Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.

引用

页数：10

共 46 条

[1] AHA, 2017, AHA DAT DAT CHIC IL
[2] American College of Surgeons
[3] American Society forMetabolic and Bariatric Surgery, 2016, MET BAR SURG ACCR QU
[4] American Society for Metabolic and Bariatric Surgery, 2015, EST BAR SURG NUMB 20
[5] American Society for Metabolic and Bariatric Surgery, 2013, JOINT TASK FORC REC
[6] Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014
Angrisani, L.
Santonicola, A.
Iovino, P.
Vitiello, A.
Zundel, N.
Buchwald, H.
Scopinaro, N.
[J]. OBESITY SURGERY, 2017, 27 (09) : 2279 - 2289
[7] [Anonymous], STAND MAN V2 0 RES O
[8] [Anonymous], 2015, The Boston Globe
[9] [Anonymous], 2016, CONCURRENT OVERLAPPI
[10] A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on Mortality
Austin, Peter C.
[J]. MULTIVARIATE BEHAVIORAL RESEARCH, 2011, 46 (01) : 119 - 151

← 1 2 3 4 5 →