Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis.
Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis.
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DOI：
10.1111/obr.12647
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Colditz GA
中科院分区：
文献类型：
--
作者：
Chang SH;Freeman NLB;Lee JA;Stoll CRT;Calhoun AJ;Eagon JC;Colditz GA
减肥手术的有效性已得到充分研究。然而，减肥手术后的并发症尚未得到充分研究。本综述评估了与减肥手术相关的<30天的主要并发症，包括吻合口瘘、心肌梗死、肺栓塞。该综述纳入了2003年至2014年在美国进行的71项研究和107，874例接受胃旁路术、可调节胃束带术或袖状胃切除术的患者，平均年龄44岁，术前体重指数46.5 kg/m2。术后30 d内吻合口瘘发生率为1.15%，心肌梗死发生率为0.37%，肺栓塞发生率为1.17%。吻合口瘘、心肌梗死和肺栓塞的死亡率分别为0.12%、0.37%和0.18%。在外科手术中，术后<30天，袖状胃切除术（1.21% [95%CI，0.23%-2.19%]）的吻合口瘘发生率高于胃旁路术（1.14% [95%CI，0.84%-1.43%]）;胃旁路术的心肌梗死和肺栓塞发生率高于可调节胃束带术或袖状胃切除术。在审查过程中，我们发现并发症报告的质量低于其他结局的报告。总之，任何一种手术后<30天的三种主要并发症发生率范围为0- 1.55%。这些并发症的死亡率范围为0- 0.64%。未来的研究报告减肥手术后并发症应提高其报告质量。
The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30 day major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction, pulmonary embolism. This review included 71 studies conducted in the United States between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding, or sleeve gastrectomy, with mean age 44 years and pre-surgery body mass index 46.5 kg/m2. <30 day anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction, pulmonary embolism was 0.12%, 0.37%, and 0.18%, respectively. Among surgical procedures, <30 day after surgery, sleeve gastrectomy (1.21% [95% CI, 0.23%-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% CI, 0.84%-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30 day rates of the three major complications after either one of the procedures ranges from 0-1.55%. Mortality following these complications ranges from 0-0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
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