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1.
《Surgery for obesity and related diseases》2020,16(1):65-70
BackgroundBariatric surgery results in an improvement in quality of life, co-morbid diseases, and an increased life expectancy. However, to obtain these benefits perioperative mortality rates need to be low.ObjectivesEvaluate 90-day and 1-year mortality after bariatric surgery in Sweden from 2008 to 2017.SettingNational quality register.MethodsData on applicable patients from the Scandinavian Obesity Surgery Registry, including 63,469 patients (85.1% gastric bypass, 12.5% sleeve gastrectomy, .8% duodenal switch, .5% minor revisions, and 1.1% other procedures), were retrieved and matched to the Cause of Death registry.ResultsDuring the 10-year period, 36 patients died within 90 days, resulting in a .06% overall mortality. The 1-year mortality rate was .19% (n = 111). Both mortality rates decreased over the study period. In a multivariate analysis, depression (odds ratio [OR] 2.38, [95% confidence interval 1.48–3.84]), leakage (OR 9.32 [4.85–17.94]), and thromboembolic events (OR 7.60 [1.63–35.37]) increased mortality risks at both 90 days and 1 year, whereas age (OR 1.03 [1.01–1.06] per increased year of age) and abdominal circumference (OR 1.03 [1.01–1.05] per cm) were also associated with increased mortality at 1 year. The predictive value of the Obesity Surgery Mortality Risk Score was confirmed.ConclusionsThe low 90-day and 1-year mortality, .06% and .19%, respectively, demonstrates that bariatric surgery in Sweden is safe. The use of antidepressants and 2 serious postoperative complications were the most significant risk factors for early deaths, while increased age and preoperative abdominal circumference also contributed at 1 year. 相似文献
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3.
《Surgery for obesity and related diseases》2023,19(9):1013-1022
BackgroundMale patients are underrepresented in bariatric surgery (BS) despite a relatively equal proportion of men and women experiencing obesity.ObjectivesDifferences in frequency and severity of obesity-associated medical problems (OAMPs) between men and women undergoing BS or in a control group (HELIUS [HEalthy Life In an Urban Setting]) were evaluated. The hypothesis was that men undergoing BS are less healthy than women.SettingA cross-sectional study of 2 cohorts undergoing BS in 2013 (BS2013) and 2019 (BS2019) and a control group of patients with severe obesity from a general population (HELIUS).MethodsCharacteristics concerning weight and OAMPs, medication usage, intoxications, postoperative complications (for BS2019) were compared between men and women. Members of the HELIUS cohort were tested for eligibility for BS.ResultsOf 3244 patients included, the majority were female (>78.4%). Median (interquartile range) age and body mass index (kg/m2) in male versus female patients were 47.0 (41.0–53.8) versus 43.0 (36.0–51.0) years and 41.5 (38.4–45.2) versus 42.3 (40.2–45.9), respectively, in BS2013, and 52.0 (39.8–57.0) versus 45.0 (35.0–53.0) years and 40.4 (37.4–43.8) versus 41.3 (39.0–44.1) in BS2019 (P < .05). The rates of men with OAMPs were 71.4% and 82.0% compared with 50.2% and 56.9% of women in BS2013 and BS2019, respectively. Overall medication usage was higher in male patients (P = .014). In BS2019, male patients exhibited a higher median HbA1C (P < .001) and blood pressure (P = .003) and used more antihypertensives and antidiabetics (P = .004). Postoperative complications did not differ between men and women. In the control cohort, 66.5% of men and 66.6% of women were eligible for BS.ConclusionMen undergoing BS more often experience OAMPs than women, and OAMPs are more advanced in men. 相似文献
4.
《Surgery for obesity and related diseases》2022,18(8):1057-1065
BackgroundPostoperative bleeding remains a relatively common complication following bariatric surgery and may lead to morbidity and even mortality.ObjectiveTo develop a prediction model to identify patients at risk for postoperative bleeding.SettingRode Kruis Ziekenhuis, Beverwijk, the Netherlands. Based on Dutch nationwide obesity audit data.MethodsPatients undergoing primary bariatric surgery were selected from January 2015 to December 2020 from the Dutch Audit for Treatment of Obesity. The primary outcome was postoperative bleeding within 30 days. Assessed predictors included patient factors and operative data. A prediction model was developed using backward stepwise logistic regression. Internal validation was performed using bootstrapping techniques.ResultsA total of 59,055 patients were included; 13,399 underwent a sleeve gastrectomy, and 45,656 underwent a gastric bypass procedure. Postoperative bleeding occurred in 1.5%. The following predictors were identified: male patients (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.21–1.63), patients >45 years of age (OR = 1.50; 95% CI: 1.29–1.76), body mass index <40 kg/m2 (OR = 1.22; 95% CI: 1.06–1.41), cardiovascular disease (OR = 1.36; 95% CI: 1.17–1.57), and sleeve gastrectomy (OR = 1.43; 95% CI: 1.24–1.67). Area under the curve for the model was .612. Following bootstrapping for internal validation, a correction of .9817 was applied.ConclusionA clinical decision rule was designed to assess the risk of postoperative bleeding in patients undergoing bariatric surgery. If 3 or more risk factors are present, there is an increased risk for postoperative bleeding. The model can aid in clinical decision-making: implementing extra preventative measures in high-risk patients. External validation is needed to further develop the model. 相似文献
5.
《Surgery for obesity and related diseases》2020,16(8):1133-1144
Published estimates of weight regain (WR) after bariatric surgery vary greatly. Understanding the sources of variability in the literature and clarifying the magnitude of WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are critical for informing expectations and planning interventions. A literature search through January 2019 yielded 15 English-language studies that reported WR in at least 30 participants, not selected based on weight loss or WR, at least 3 years after primary RYGB (n = 11) or SG (n = 5). Median follow-up was 5.0 (range, 3.2–10.0) years. Median sample size was 62 (range, 33–464). Samples represented a median of 54.3% (range, 10.7%–100%) of eligible participants. Nadir weight was determined by serial research assessments (n = 1), medical records (n = 7), participant recall (n = 4), or an undisclosed method (n = 4). Three continuous and 8 binary WR measures (the latter, based on various thresholds for clinically meaningful WR) were reported. To enable comparison across studies, the percentage difference in WR in each study versus a reference sample (n = 1433 RYGB), matched on time since surgery and WR measure, was calculated. Median WR in the reference sample increased from 8.2 (25th–75th percentile: 0–19.5) to 23.8 (25th–75th percentile: 9.0–33.9) percent of maximum weight lost, 3 to 6 years post RYGB surgery. Studies of RYGB versus SG, with larger versus smaller samples, with higher versus lower participation rates, that determined nadir weight via participant recall versus medical records, and reported continuous versus binary WR measures tended to have WR values closer to the reference sample and each other. Variation in WR estimates was explained by heterogeneity in WR measures, timing of assessment, surgical procedure, and study design characteristics. The best estimate of WR after RYGB likely comes from the large reference sample. WR after SG versus RYGB appears higher. However, additional high-quality studies with uniform reporting of WR by surgical procedure are needed. 相似文献
6.
《American journal of surgery》2020,219(6):952-957
IntroductionLaparoscopic Roux-en-Y gastric bypass (LRYGB) is known to increase risk for calcium oxalate nephrolithiasis due to hyperoxaluria; however, nephrolithiasis rates after laparoscopic sleeve gastrectomy (LSG) are not well described. Our objective was to determine the rate of nephrolithiasis after LRYGB versus LSG.MethodsThe electronic medical records of patients who underwent LRYGB or LSG between 2001 and 2017 were retrospectively reviewed.Results1,802 patients were included. Postoperative nephrolithiasis was observed in 133 (7.4%) patients, overall, and 8.12% of LRYGB (122/1503) vs. 3.68% of LSG (11/299) patients (P < 0.001). Mean time to stone formation was 2.97 ± 2.96 years. Patients with a history of UTI (OR = 2.12, 95%CI 1.41–3.18; P < 0.001) or nephrolithiasis (OR = 8.81, 95%CI 4.93–15.72; P < 0.001) were more likely to have postoperative nephrolithiasis.ConclusionThe overall incidence of symptomatic nephrolithiasis after bariatric surgery was 7.4%. Patients who underwent LRYGB had a higher incidence of nephrolithiasis versus LSG. Patients with a history of stones had the highest risk of postoperative nephrolithiasis. 相似文献
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Aly Elbahrawy Alexandre Bougie Sarah-Eve Loiselle Sebastian Demyttenaere Olivier Court Amin Andalib 《Surgery for obesity and related diseases》2018,14(4):470-476
Background
Indications and outcomes of bariatric surgery in older adults suffering from morbid obesity remain controversial. We aimed to evaluate safety and medium to long-term outcomes of bariatric procedures in this patient population.Setting
University Hospital, Canada.Methods
This is a single-center retrospective study of a prospectively collected database. We included patients aged ≥60 years who underwent sleeve gastrectomy, Roux-en-Y gastric bypass, or biliopancreatic diversion with duodenal switch between January 2006 and December 2014 and had at least 2 years of follow-up.Results
Of patients, 115 underwent bariatric surgeries (11 patients had 2 procedures). There were 66 were super-obese patients (body mass index>50 kg/m2). Of patients, 74% had sleeve gastrectomy, 16% Roux-en-Y gastric bypass, and 8% underwent biliopancreatic diversion with duodenal switch. Mean age and body mass index were 63.3 ± 2.6 years and 51.7 ± 8.1 kg/m2, respectively. Average follow-up time was 42 ± 19 months. At baseline, 78% had hypertension, 60% had type 2 diabetes, and 30% had obstructive sleep apnea. There was no 30-day mortality. Complication rate was 14% (n = 16): 2 leaks post–Roux-en-Y gastric bypass, 1 leak post–biliopancreatic diversion with duodenal switch, 1 obstruction post–sleeve gastrectomy, 1 bleeding requiring transfusion, 1 liver injury with bile leak, 2 port-site hernias, 1 myocardial infarction, 2 gastrojejunal strictures, 1 wound infection, 1 urinary tract infection, and 3 gastric reflux exacerbations. Mean percent excess weight loss at 2 years was 52.2 ± 23.8. Remission rates of hypertension, type-2 diabetes, and obstructive sleep apnea were 26%, 44%, and 38%, respectively.Conclusion
Bariatric surgery is safe and effective in improving obesity-related co-morbidities in older patients suffering from morbid obesity. Age alone should not preclude older patients from getting the best bariatric procedure for obesity and related co-morbidities. 相似文献8.
9.
《Surgery for obesity and related diseases》2020,16(11):1673-1682
BackgroundDespite the publication of the American Society for Metabolic and Bariatric Surgery (ASMBS) Outcome Reporting Standards in 2015, there is still a great variety in definitions used for reporting remission of co-morbidities after bariatric surgery. This hampers meaningful comparison of results.ObjectiveTo assess compliance with the ASMBS standards in current literature, and to evaluate use of the standards by applying them in a report on the outcomes of 5 co-morbidities after bariatric surgery.SettingTwo clinics of the Dutch Obesity Clinic, location Den Haag and Velp, and three affiliated hospitals: Haaglanden Medical Center in Den Haag, Groene Hart Hospital in Gouda, and Vitalys Clinic in Velp.MethodsA systematic search in PubMed was conducted to identify studies using the ASMBS standards. Besides, the standards were applied to a cohort of patients who underwent a primary bariatric procedure between November 2016 and June 2017. Outcomes of co-morbidities were determined at 6 and 12 months after surgery.ResultsTen previous studies applying ASMBS definitions were identified by the search, including 6 studies using portions of the definitions, and 4 using complete definitions for 3 co-morbidities or in a small population. In this study, the standards were applied to 1064 patients, of whom 796 patients (75%) underwent Roux-en-Y gastric bypass and 268 patients (25%) underwent sleeve gastrectomy. At 12 months, complete remission of diabetes (glycosylated hemoglobin <6%, off medication) was reached in 63%, partial remission (glycosylated hemoglobin 6%–6.4%, off medication) in 7%, and improvement in 28% of patients (n = 232/248, 94%). Complete remission of hypertension (normotensive, off medication) was noted in 8%, partial remission (prehypertensive, off medication) in 23% and improvement in 63% (n = 397/412, 96%). Remission rate for dyslipidemia (normal nonhigh-density lipoprotein, off medication) was 57% and improvement rate was 19% (n = 129/133, 97%). Resolution of gastroesophageal reflux disease (no symptoms, off medication) was observed in 54% (n = 265/265). Obstructive sleep apnea syndrome improved in 90% (n = 157/169, 93%).ConclusionsCompliance with the ASMBS standards is low, despite ease of use. Standardized definitions provided by the ASMBS guideline could be used in future research to enable comparison of outcomes of different studies and surgical procedures. 相似文献
10.
Benedict Y. Hui Zhamak Khorgami Justin S. Puthoff Timothy S. Kuwada Robert B. Lim Geoffrey S. Chow 《Surgery for obesity and related diseases》2021,17(4):667-672
BackgroundIdentifying patients at higher risk of postoperative sepsis (PS) may help to prevent this life-threatening complication.ObjectivesThis study aimed to identify the rate and predictors of PS after primary bariatric surgery.SettingAn analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015-2017.MethodsPatients undergoing elective sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were included. Exclusion criteria were revisional, endoscopic, and uncommon, or investigational procedures. Patients were stratified by the presence or absence of organ/space surgical site infection (OS-SSI), and patients who developed sepsis were compared with patients who did not develop sepsis in each cohort. Logistic regression was used to identify independent predictors of PS.ResultsIn total, 438,752 patients were included (79.4% female, mean age 44.6±12 years). Of those, 661 patients (.2%) developed PS of which 245 (37.1%) developed septic shock. Out of 892 patients with organ/space surgical site infections (OS-SSI), 298 (45.1%) developed sepsis (P <.001). Patients who developed PS had higher mortality (8.8% versus .1%, P < .001), and this was highest in patients without OS-SSI (11.8% versus 5%, P = .002). The main infectious complications associated with PS in patients without OS-SSI were pneumonia and urinary tract infection. Independent predictors of PS in OS-SSI included RYGB versus SG (OR, 1.8), and age ≥50 years (OR, 1.4). Independent predictors of PS in patients without OS-SSI were conversion to other approaches (OR, 6), operation length >2 hours (OR, 5.7), preoperative dialysis (OR, 4.1), preoperative therapeutic anticoagulation (OR, 2.8), limited ambulation most or all of the time (OR, 2.4), preoperative venous stasis (OR, 2.4), previous nonbariatric foregut surgery (OR, 2), RYGB versus SG (OR, 2), hypertension on medication (OR, 1.5), body mass index ≥50 kg/m2(OR, 1.4), age ≥50 years (OR, 1.3), obstructive sleep apnea (OR, 1.3).ConclusionDevelopment of OS-SSI after primary bariatric surgery is associated with sepsis and increased 30-day mortality. Patients without OS-SSI who develop PS have a significantly higher mortality rate compared with patients with OS-SSI who develop PS. Early identification and intervention in patients with PS, including those without OS-SSI, may improve survival in this high-risk group. 相似文献
11.
IntroductionA BMI of over 35–45 kg/m2 is deemed the upper limit for considering a patient for a renal transplant. Voluntary weight loss attempts are a major concern for patients while on hemodialysis, however, bariatric surgeries have opened up a new door to notable weight loss results, even demonstrating significant improvements of patients’ diabetic profile and hypertension.Case reportCase of a 52-year-old male with a BMI of 42 in end-stage renal disease, that needed a kidney transplant but was ineligible to be placed on the waiting list due to his weight. A laparoscopic sleeve gastrectomy (LSG) was performed to aid with his weight loss. He also showed major improvements in his hypertension and diabetes profiles. The patient started gaining weight as well as showing deterioration in his diabetic control. He underwent the renal transplant 1.5 years post LSG, after which he showed improvements in his blood results, diabetic and hypertensive control. However, his weight began to increase again, for which he underwent gastric bypass. Since then, the patients' glucose, BUN and creatinine have normalized and his weight continued to drop, reaching a BMI of 31.83 kg/m2 2 years post bypass.ConclusionBariatric surgery is a safe and effective procedure to assist renal transplant patients in losing weight. In addition, it has proven to be effective in the management of the co-morbidities that are associated with renal failure. Our study was also able to prove that converting form an SG to a bypass in a transplant patient is a safe and feasible option. 相似文献
12.
《Surgery for obesity and related diseases》2014,10(2):313-321
BackgroundRapid weight loss after bariatric surgery is associated with gallstone formation, and cholecystectomy is required in up to 15% of patients. Prophylactic cholecystectomy or prophylactic ursodiol administration in the postoperative period have been suggested to address this problem. The objectives of this study were to investigate the frequency and timing of cholecystectomies after bariatric surgery and to determine the associated risk factors in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric band (LAGB), or laparoscopic sleeve gastrectomy (LSG).MethodsData prospectively collected in an institutional database were analyzed. Differences among the 3 procedures and the effects of ursodiol administration, patient demographic characteristics, postoperative weight loss, and individual surgeon practices on cholecystectomy rates were examined. Survival analysis and proportional hazard models were used.ResultsOf 1398 patients, 109 (7.8%) underwent cholecystectomy with a median follow-up of 49 (range 12–103) months. Cholecystectomy frequency was 10.6% after LRYGB, significantly higher than 2.9% after LAGB (P<.001), and 3.5% after LSG (P = .004). The frequency was highest within the first 6 months (3.7%), but declined over time to<1% per year after 3 years. Ursodiol administration did not affect cholecystectomy rates (P = .97), and significant intersurgeon variability was noted. Excess weight loss (EWL)>25% within the first 3 months was the strongest predictor of postoperative cholecystectomy (P<.001). Cox hazards model revealed 1.25 odds ratio per 10% EWL within 3 months, and odds ratio .77 per decade of life. In addition, white patients had 1.45 times higher cholecystectomy rates than did black patients. Preoperative body mass index, gender, and surgeon did not affect cholecystectomy rates.ConclusionBariatric surgery is associated with a low frequency of postoperative cholecystectomy, which is highest early after surgery and mainly determined by the amount of EWL within the first 3 months. The results of the present study do not support routine prophylactic cholecystectomy at the time of bariatric surgery in asymptomatic patients. 相似文献
13.
《Surgery for obesity and related diseases》2023,19(3):195-202
BackgroundGeriatric patients have a greater risk of complications after bariatric surgery. The objective of this study was to develop a tool to predict serious complications in geriatric patients after minimally invasive bariatric surgery.ObjectivesTo develop a predictive model, GeriBari, for serious complications in geriatric patients after bariatric surgery.SettingMultiple accredited bariatric surgery centers in the United States and Canada.MethodsThis was a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, which collects 30-day bariatric surgery outcomes from 868 accredited centers. Geriatric patients defined as those ≥65 years old who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. Characteristics associated with serious complications were identified using univariate and multivariable analyses. A predictive model, GeriBari, was derived using a forward selection algorithm from operative years 2015, 2017, and 2019. GeriBari’s robustness was tested against a validation cohort of subjects from operative years 2016 and 2018.ResultsA total of 40,199 geriatric patients underwent LRYGB (27.7%) or LSG (72.3%). Overall, 1866 (4.6%) experienced a complication, which included bleeding (1.6%), reoperation (1.6%), reintervention (1.3%), unplanned intubation (.4%), and pneumonia (.4%). Mortality was higher in the geriatric patients than that in younger patients (.27% versus .08%). GeriBari consists of 12 factors that predicted serious complications and stratified individuals into high- (>6%) and low-risk (<6%) groups. This tool accurately predicted events in the validation cohort with sensitivity of 46.0% and specificity of 100%.ConclusionsGeriBari enables preoperative risk stratification for 30-day serious complications in geriatric patients undergoing bariatric surgery. Stratifying low- and high-risk geriatric patients for adverse events allows for informed clinical decision-making prior to bariatric surgery. 相似文献
14.
Sergio Susmallian Royi Barnea Yossi Weiss Asnat Raziel 《Surgery for obesity and related diseases》2018,14(11):1705-1713
Background
People are living longer than they were expected to 2 decades ago. Increased life expectancy and reduced mortality encompasses a simultaneous increase in the number of older adults with obesity that entails an increase of co-morbidities, such as diabetes, hypertension, cancer, and many other diseases. The aim of our study was to compare the outcomes of bariatric surgery in patients age ≥65 in comparison with younger patients.Methods
This retrospective study compares bariatric surgeries performed in a private institution between the years 2013 and 2015. The study included 9044 patients divided into an older group (451 patients) and the younger group (8593 patients).Results
In the younger group, bariatric surgery is distributed as follows: 77.68% sleeve gastrectomy, 12.72% gastric banding, 9.27% gastric bypass, and .33% duodenal switch or biliopancreatic diversion; in the older group: 70.51% sleeve gastrectomy, 15.08% gastric bypass, 13.97% gastric band, and .44% biliopancreatic diversion. In the control group 550 cases (6.4%) underwent revisional surgery; 64 cases (14.10%) underwent revision in the older group. Older patients lost less excess weight than younger patients (72.44% versus 86.11%, respectively). Older patients presented higher rates of complications (8.42% versus 5.59%), co-morbidities (77.60% versus 55.45%), and revisions (1.33% versus .77%). There was no statistical difference in hospital stay between older group and control group (2.27 versus 2.23, respectively). When performing a Clavien-Dindo classification, we demonstrated significant differences in class 3B and 4A and no differences in other classes. Two deaths occurred in the control group. Diabetes, fatty liver, and sleep apnea have been improved or remitted in >90% of patients in both groups, hypertension and hyperlipidemia by >80%, and hyperuricemia and ischemic heart disease were improved or resolved in >70% of the patientsConclusions
Bariatric surgery in the elderly has more complications, but it can still be considered safe. 相似文献15.
Charles J. Keith Lauren E. Goss Camille D. Blackledge Richard D. Stahl Jayleen Grams 《Surgery for obesity and related diseases》2018,14(5):631-636
Background
Despite a lack of demonstrated patient benefit, many insurance providers mandate a physician-supervised diet before financial coverage for bariatric surgery.Objectives
To compare weight loss between patients with versus without insurance mandating a preoperative diet.Setting
University hospital, United States.Methods
Retrospective study of all patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy over a 5-year period, stratified based on whether an insurance-mandated physician-supervised diet was required. Weight loss outcomes at 6, 12, and 24 months postoperation were compared. Linear mixed-models and backward-stepwise selection were used. P<0.05 was considered significant.Results
Of 284 patients, 225 (79%) were required and 59 (21%) were not required to complete a preoperative diet by their insurance provider. Patients without the requirement had a shorter time to operation from initial consultation (P = .04), were older (P<.01), and were more likely to have government-sponsored insurance (P<.01). There was no difference in preoperative weight or body mass index or co-morbidities. In unadjusted models, percent excess weight loss was superior in the group without an insurance-mandated diet at 12 (P = .050) and 24 (P = .045) months. In adjusted analyses, this group also had greater percent excess weight loss at 6 (P<.001), 12 (P<.001), and 24 (P<.001) months; percent total weight loss at 24 months (P = .004); and change in body mass index at 6 (P = .032) and 24 (P = .007) months. There was no difference in length of stay or complication rates.Conclusions
Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss. 相似文献16.
《Surgery for obesity and related diseases》2022,18(10):1246-1252
BackgroundRevisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity.ObjectiveTo evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center.SettingDepartment of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain.MethodsRetrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed.ResultsSix hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P = .017). Mean initial body mass index was 44.2 kg/m2 (RYGB-RS) versus 47.6 kg/m2 (RYGB-1; P = .004). Cardiovascular risk factors were higher in the RYGB-1 group (P < .05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien–Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P > .05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%).ConclusionNo differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands. 相似文献
17.
《Surgery for obesity and related diseases》2019,15(10):1805-1811
BackgroundAlthough bariatric surgery is an effective treatment for obesity, utilization of bariatric procedures in older adults remains low. Previous work reported higher morbidity in older patients undergoing bariatric surgery. However, the generalizability of these data to contemporary septuagenarians is unclear.ObjectivesWe sought to evaluate differences in 30-day outcomes, 1-year weight loss, and co-morbidity remission after bariatric surgery among 3 age groups as follows: <45 years, 45–69 years, and ≥70 years.SettingStatewide quality improvement collaborative.MethodsUsing a large quality improvement collaborative, we identified patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2006 and 2018. We used multivariable logistic regression models to evaluate the association between age cohorts and 30-day outcomes, 1-year weight loss, and co-morbidity remission.ResultsWe identified 641 septuagenarians who underwent SG (68.5%) or RYGB (31.5%). Compared with 45–69 year olds, septuagenarians had higher rates of hemorrhage (5.1% versus 3.1%; P = .045) after RYGB and higher rates of leak/perforation (.9% versus .3%; P = .044) after SG. Compared with younger patients, septuagenarians lost less of their excess weight, losing 64.8% after RYGB and 53.8% after SG. Remission rates for diabetes and obstructive sleep were similar for patients aged ≥70 years and 45–69 years.ConclusionsBariatric surgery in septuagenarians results in substantial weight loss and co-morbidity remission with an acceptable safety profile. Surgeons with self-imposed age limits should consider broadening their selection criteria to include patients ≥70 years old. 相似文献
18.
《Surgery for obesity and related diseases》2022,18(3):357-364
BackgroundMajor adverse cardiac events (MACEs) after bariatric surgery are poorly understood yet are thought to be associated with significant morbidity and mortality.ObjectivesTo evaluate the prevalence and clinical impact of short-term, 30-day MACE and to develop a pragmatic clinical predictive MACE scoring tool.SettingThis retrospective study was conducted using all the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)–accredited center data from 2015 to 2019.MethodsPrimary Roux-en-Y and sleeve gastrectomy procedures were included, and prior revisional surgeries and emergency surgeries were excluded. Multivariable logistic regression modeling was used to examine the risk factors associated with 30-day MACE. Using forward regression, a Bari-MACE clinical prediction model was generated.ResultsA total of 750,498 patients were included in our analysis of which 959 (.1%) experienced a MACE. MACE patients were older (54.0 ± 11.5 yr versus 44.4 ± 12.0 yr, P < .0001), and comprised a higher proportion of males (36.3% versus 20.4%, P < .0001) and patients of White racial status (74.0% versus 71.6%, P < .0001). The MACE cohort also had a higher body mass index (46.6 ± 9.7 kg/m2 versus 45.2 ± 7.8 kg/m2, P < .0001), higher rates of sleep apnea (56.8% versus 38.2%, P < .0001), and a higher proportion of insulin-dependent diabetes (26.1% versus 8.4%, P < .0001) than non-MACE patients. Derivation of our clinical predictive Bari-MACE scoring model revealed 12 variables associated with development of MACE with a specificity of 97.8% using a 55-point threshold.ConclusionThirty-day major adverse cardiac events after elective bariatric surgery are rare, occurring in approximately .1% of all patients, but are associated with significant morbidity and mortality. Using the MBSAQIP, we developed a Bari-MACE clinical predictive tool to risk-stratify patients with the aim to better guide perioperative care and foster improved surgical outcomes. 相似文献
19.
《Surgery for obesity and related diseases》2022,18(10):1239-1245
BackgroundDuring the COVID-19 pandemic, surgical centers had to weigh the benefits and risks of conducting bariatric surgery. Obesity increases the risk of developing severe COVID-19 infections, and therefore, bariatric surgery is beneficial. In contrast, surgical patients who test positive for COVID-19 have higher mortality rates.ObjectiveThis study investigates the national prevalence of postoperative pneumonia during the COVID-19 pandemic in the bariatric surgery population.SettingThe American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database.MethodsThis is a cross-sectional study using the ACS-NSQIP database. The population of concern included patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Information was extracted on rate of postoperative pneumonia and other 30-day complications between 2018 and 2020.ResultsAll baseline characteristics were similar among patients who underwent bariatric surgery between 2018 and 2020. However, there was a 156% increase in postoperative pneumonia in 2020 compared with the previous year. Furthermore, despite the similar postoperative complication rates across the years, there was a statistically significant increase in all-cause mortality in 2020. The multivariate analysis showed that having surgery in 2020 was a statistically significant risk factor for pneumonia development postoperatively.ConclusionsThis study showed a statistically significant increase in the prevalence of postoperative pneumonia during the COVID-19 pandemic among bariatric surgery patients. Surgical centers must continuously evaluate the risks associated with healthcare-associated exposure to COVID-19 and weigh the benefits of bariatric surgery. 相似文献
20.
Saeed Shoar Alan A. Saber Rebecca Rubenstein Saeed Safari Stacy A. Brethauer Hassan Al-Thani Armand P. Asarian Ali Aminian 《Surgery for obesity and related diseases》2018,14(1):47-59