Hospital Complication Rates With Bariatric Surgery in Michigan
Hospital Complication Rates With Bariatric Surgery in Michigan
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DOI：
10.1001/jama.2010.1034
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发表时间：
2010-07-28
影响因子：
120.7
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
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作者：
Birkmeyer, Nancy J. O.;Dimick, Justin B.;Birkmeyer, John D.
尽管减肥手术越来越受欢迎，但仍存在对围手术期安全性和各医院预后差异的担忧。目的评估不同减肥手术的并发症发生率以及不同医院、不同手术量和不同卓越中心（COE）状态下严重并发症发生率的差异。密歇根减肥外科合作组织（MBSC）管理着一个外部审计的前瞻性临床登记系统，涉及全州25家医院和62名外科医生。我们评估了2006年至2009年间密歇根州15275名接受三种常见减肥手术中的一种的患者的短期发病率。我们使用多水平回归模型来评估各医院风险调整并发症发生率的变化，以及手术量和COE指定（由美国外科医师学会或美国代谢与减肥外科学会）状态的影响。主要观察指标手术30天内发生的并发症。结果总的来说，7.3%的患者出现围手术期并发症，其中大部分是伤口问题和其他轻微并发症。胃旁路术后最常见的是严重并发症（3.6%；95%可信区间[CI]， 3.2%-4.0%），其次是袖胃切除术（2.2%;95% CI, 1.2%-3.2%）和腹腔镜下可调节胃束（0.9%;95% CI, 0.6%-1.1%）
Context Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals.Objective To assess complication rates of different bariatric procedures and variability in rates of serious complications across hospitals and according to procedure volume and center of excellence (COE) status.Design, Setting, and Patients Involving 25 hospitals and 62 surgeons statewide, the Michigan Bariatric Surgery Collaborative (MBSC) administers an externally audited, prospective clinical registry. We evaluated short-term morbidity in 15 275 Michigan patients undergoing 1 of 3 common bariatric procedures between 2006 and 2009. We used multilevel regression models to assess variation in risk-adjusted complication rates across hospitals and the effects of procedure volume and COE designation (by the American College of Surgeons or American Society for Metabolic and Bariatric Surgery) status.Main Outcome Measure Complications occurring within 30 days of surgery.Results Overall, 7.3% of patients experienced perioperative complications, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6%; 95% confidence interval [CI], 3.2%-4.0%), followed by sleeve gastrectomy (2.2%; 95% CI, 1.2%-3.2%), and laparoscopic adjustable gastric band (0.9%; 95% CI, 0.6%-1.1%) procedures (P