Volume-outcome relationships for Roux-en-Y gastric bypass patients in the sleeve gastrectomy era.
Volume-outcome relationships for Roux-en-Y gastric bypass patients in the sleeve gastrectomy era.
复制标题
袖状胃切除术时代 Roux-en-Y 胃绕道手术患者的容量与结果关系。
DOI：
10.1007/s00464-021-08705-6
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Dimick,JustinB
中科院分区：
文献类型：
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作者：
Chao,GraceF;Yang,Jie;Thumma,Jyothi;Chhabra,KaranR;Arterburn,DavidE;Ryan,Andrew;Telem,DanaA;Dimick,JustinB
背景：间歇性胃切除术是目前最常见的减肥手术。随着Roux-en-Y胃分流术(RYGB)数量的减少，尚不清楚外科医生经验的减少是否导致了这种手术结果的恶化。方法我们使用了佛罗里达州、爱荷华州、纽约州和华盛顿州的州立住院患者数据库。减肥外科医生被指定为那些每年进行10次或更多减肥手术的人。患有RYGB的患者包括在我们的分析中。我们使用多水平Logistic回归分析外科医生年平均RYGB量是否与RYGB患者30天并发症、再手术和再入院以及1年修订和再入院相关。结果从2013年到2017年，311名外科医生共27,714名患者接受了RYGB。外科医生数量中位数为每年77 RYGB。分布为每年5百分位搭桥10次，第10百分位搭桥16次，第25百分位搭桥38次，第75百分位搭桥133次。多水平回归显示，RYGB容量较小的外科医生的患者30天并发症和1年再入院的风险较小，但在统计学上显著增加。术后30天，每年搭桥10次、38次和133次时发生并发症的风险分别为6.71%、6.43%和5.55%(p= 0.01)。每年搭桥10次、38次和133次时再入院的风险分别为13.90%、13.67%和12.90%(p= 0.099)。值得注意的是，容量与出血和渗漏引起的并发症和再手术之间的相关性在统计学上并不显著。结论随着全国RYGB经验的减少，这是第一项研究外科医生RYGB容量与患者预后之间的关系。总体而言，外科医生的RYGB容量似乎对患者的预后没有太大影响。因此，在袖状胃切除术时代的早期阶段，患者可以安全地追求RYGB。
BackgroundSleeve gastrectomy is now the most common bariatric operation performed. With lower volumes of Roux-en-Y gastric bypass (RYGB), it is unclear whether decreasing surgeon experience has led to worsening outcomes for this procedure.MethodsWe used State Inpatient Databases from Florida, Iowa, New York, and Washington. Bariatric surgeons were designated as those who performed ten or more bariatric procedures yearly. Patients who had RYGB were included in our analysis. Using multi-level logistic regression, we examined whether surgeon average yearly RYGB volume was associated with RYGB patient 30-day complications, reoperations, and readmissions and 1-year revisions and readmissions.ResultsFrom 2013 to 2017 there were 27,714 patients who underwent laparoscopic RYGB by 311 surgeons. Median surgeon volume was 77 RYGBs per year. The distribution was 10 bypasses yearly at the 5th percentile, 16 bypasses at the 10th percentile, 38 bypasses at the 25th percentile, and 133 bypasses at the 75th percentile.Multi-level regression revealed that patients of surgeons with lower RYGB volumes had small but statistically significant increased risks of 30-day complications and 1-year readmissions. At 30 days, risk for any complication was 6.71%, 6.43%, and 5.55% at 10, 38, and 133 bypasses per year, respectively (p= 0.01). Risk for readmission at 1 year was 13.90%, 13.67%, and 12.90% at 10, 38, and 133 bypasses per year, respectively (p= 0.099). Of note, volume associations with complications and reoperations due to hemorrhage and leak were not statistically significant. There was also no significant association with revisions.ConclusionThis is the first study to examine the association of surgeon RYGB volume with patient outcomes as the national experience with RYGB diminishes. Overall, surgeon RYGB volume does not appear to have a large effect on patient outcomes. Thus, patients can safely pursue RYGB in this early phase of the sleeve gastrectomy era.