Procedure-Specific Early Complications Following Bariatric Surgery: A High-Volume Single-Institution Analysis.

IF 1.2 4区 医学 Q3 SURGERY
Kamal Abi Mosleh, Noura Jawhar, Yara Salameh, Wissam Ghusn, Nour El Ghazal, Todd A Kellogg, Omar M Ghanem
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引用次数: 0

Abstract

Background: Metabolic and bariatric surgery (MBS) is an established treatment for severe obesity and its related comorbidities. While long-term outcomes are often emphasized, early postoperative complications remain a critical metric of safety and resource utilization. Large database studies have reported national trends in MBS outcomes but are limited by lack of granularity, inconsistent definitions, and inclusion of heterogeneous surgical experience. This study aimed to provide a detailed analysis of 30-day postoperative complications following sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) over a 17-year period at a single high-volume quaternary academic center.

Materials and methods: A retrospective cohort study of adult patients who underwent primary laparoscopic SG, RYGB, or DS between 2008 and 2024. All procedures were performed by fellowship-trained, minimally invasive bariatric surgeons. Complications occurring within 30 days postoperatively were identified through comprehensive chart review and classified using the Clavien-Dindo grading system. Primary outcomes included incidence, severity, and type of complications, as well as rates of readmission, reoperation, and reintervention. Multivariable logistic regression was used to identify predictors of overall and major complications.

Results: Of 2190 patients included, 413 (18.9%) experienced at least 1 early complication, totaling 467 discrete events. DS had the highest complication rate (29.3%), followed by RYGB (18.4%) and SG (17.5%). RYGB was associated with a high burden of major complications, including anastomotic strictures, GI bleeding, and reoperations for obstruction or leak. The 30-day rates of readmission (2.0%) and reoperation (1.3%) were low across all groups. Independent predictors of major complications included venous stasis (aOR=3.22), renal insufficiency (aOR=2.65), and type 2 diabetes (aOR=1.96); both RYGB (aOR=2.25) and DS (aOR=2.77) carried higher risk than SG.

Conclusion: This study provides a granular, procedure-specific profile of early complications after SG, RYGB, and DS. While all 3 procedures demonstrated acceptable safety profiles, DS had the highest overall complication rate, and RYGB carried the greatest burden of major complications. These findings underscore the variability in early postoperative outcomes by procedure type and reflect the value of institutional experience in characterizing complication profiles.

减肥手术后程序特异性早期并发症:一项大容量单机构分析。
背景:代谢和减肥手术(MBS)是一种治疗严重肥胖及其相关合并症的既定治疗方法。虽然经常强调长期结果,但术后早期并发症仍然是安全性和资源利用的关键指标。大型数据库研究报告了MBS结果的国家趋势,但由于缺乏粒度、定义不一致和包含异质手术经验而受到限制。本研究旨在详细分析17年来在单个高容量第四学术中心进行的袖式胃切除术(SG), Roux-en-Y胃旁路术(RYGB)和十二指肠切换术(DS)后30天的术后并发症。材料和方法:一项回顾性队列研究,研究对象为2008年至2024年间接受原发性腹腔镜SG、RYGB或DS的成年患者。所有手术均由接受过培训的微创减肥外科医生进行。术后30天内发生的并发症通过综合图表检查确定,并使用Clavien-Dindo分级系统进行分类。主要结局包括并发症的发生率、严重程度和类型,以及再入院、再手术和再干预的比率。多变量逻辑回归用于确定总体并发症和主要并发症的预测因子。结果:在纳入的2190例患者中,413例(18.9%)经历了至少1种早期并发症,共计467例离散事件。DS并发症发生率最高(29.3%),其次为RYGB(18.4%)和SG(17.5%)。RYGB与主要并发症的高负担相关,包括吻合口狭窄,胃肠道出血以及因阻塞或泄漏而再次手术。30天再入院率(2.0%)和再手术率(1.3%)在所有组中均较低。主要并发症的独立预测因子包括静脉淤滞(aOR=3.22)、肾功能不全(aOR=2.65)和2型糖尿病(aOR=1.96);RYGB (aOR=2.25)和DS (aOR=2.77)的风险均高于SG。结论:本研究提供了SG, RYGB和DS术后早期并发症的颗粒状,手术特异性的资料。虽然所有3种手术均表现出可接受的安全性,但DS的总并发症发生率最高,而RYGB的主要并发症负担最大。这些发现强调了不同手术类型的早期术后结果的可变性,反映了机构经验在描述并发症概况方面的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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