Surgeon variation in severity of reflux symptoms after sleeve gastrectomy
Surgeon variation in severity of reflux symptoms after sleeve gastrectomy
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袖状胃切除术后反流症状严重程度的外科医生差异
DOI：
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
J. Dimick
中科院分区：
文献类型：
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作者：
Oliver A. Varban;J. Thumma;D. Telem;N. Obeid;Jonathan F. Finks;A. Ghaferi;J. Dimick
背景：先前的研究表明腹腔镜袖状胃切除术（LSG）后胃食管反流增加。然而，尚不清楚症状的严重程度是否不同，或者结局是否因外科医生而异。方法在基线和主要LSG后1年对7358名参与2013年至2018年全州质量改进协作的患者进行了经验证的反流症状调查。根据调查评分的增加程度将术后症状恶化的患者分为三分位数（0 =无症状，50 =最大症状）。在研究期间，获得了52名减肥外科医生至少25例LSG/年的外科医生水平数据。比较了症状中度恶化最高三分位数与最低三分位数的外科医生的特征、手术经验和风险调整后的30天并发症发生率。结果2294例（31.2%）袖状胃切除术后反流症状加重。严重程度评分的总体平均增加为6.11（范围1 - 48），轻微、轻度和中度症状患者的平均增加分别为1.4、4.2和13.8。当比较症状中度恶化的最高三分位数（44.7%的患者）与最低三分位数（18.7%的患者）的外科医生时，外科医生特异性特征无显著差异。此外，外科医生在最高和最低百分位数的总体并发症（3.70% vs. 4.33%，p = 0.686）、内镜扩张（2.83% vs. 1.91%，p = 0.417）或并发食管裂孔疝修补术（34.3% vs. 27.0%，p = 0.415）的风险调整率无显著差异。结论1/3的患者LSG后反流症状加重，且症状严重程度不同。反流恶化率最高的外科医生与反流恶化率最低的外科医生相比，手术经验和并发症发生率相似。进一步评估手术技术和技能可能会提供信息。
Background Prior studies have demonstrated an increase in gastroesophageal reflux after laparoscopic sleeve gastrectomy (LSG). However, it is unknown whether symptom severity varies or if outcomes are surgeon-specific. Methods A validated reflux symptom survey was obtained at baseline and at 1 year after primary LSG on 7358 patients participating in a state-wide quality improvement collaborative between 2013 and 2018. Patients with worsening symptoms after surgery were divided into terciles based on the degree of increase in survey score (0 = no symptoms, 50 = max symptoms). Surgeon-level data was obtained on 52 bariatric surgeons performing at least 25 LSG cases/year during the study period. Surgeon characteristics, operative experience, and risk-adjusted 30-day complication rates were compared between surgeons in the highest tercile for moderate worsening of symptoms vs those in the lowest. Results A total of 2294 (31.2%) patients had worsening symptoms of reflux after sleeve gastrectomy. Overall mean increase in severity score was 6.11 (range 1 to 48) and patients with minimal, mild, and moderate symptoms had a mean increase of 1.4, 4.2, and 13.8, respectively. There were no significant differences in surgeon-specific characteristics when comparing surgeons in the highest tercile for moderate worsening of symptoms (44.7% of patients) vs those in the lowest tercile (18.7% of patients). In addition, there were no significant differences in risk-adjusted rates of overall complications (3.70% vs. 4.33%, p = 0.686), endoscopic dilations (2.83% vs. 1.91%, p = 0.417), or concurrent hiatal hernia repair (34.3% vs. 27.0%, p = 0.415) between surgeons in the highest and lowest terciles. Conclusions We found that 1/3 of patients had worsening symptoms of reflux after LSG and that severity of symptoms varied. Surgeons with the highest rates of worsening reflux had similar operative experience and complication rates than those with the lowest. Further assessment of operative technique and skill may be informative.