背景:减肥手术结果的改善促使政策举措探索将减肥手术转向门诊手术。虽然已经报道了原发性腹腔镜Roux-en-Y胃旁路术(LRYGB)后早期出院的安全性,其修订LRYGB的安全性仍不确定。我们的研究旨在调查与原发性LRYGB相比,接受改良LRYGB的患者早期出院的安全性和患者因素。
方法:我们在MBSAQIP数据库中确定了2020年至2022年接受原发性和修订版LRYGB的成年患者。患者提前出院,即,将住院患者当天出院(SDD)和次日出院(NDD)进行比较.结果包括30天并发症(次要=Clavien-Dindo1-2;主要=Clavien-Dindo3-4),死亡率,再入院,和再操作。调整患者人口统计学的多变量逻辑回归模型,合并症,和手术时间被用来评估研究结果。
结果:初次(3,422/137,406;2.5%)和修订版LRYGB(781/32,721;2.4%)后的SDD率相似,而原发性LRYGB的NDD率较高(59.8%对54.7%,分别为;p<0.001)。SDD患者发生重大并发症的几率低于原发患者(2%vs7%,OR:0.30,95CI0.24-0.38)和修订LRYGB(3.7%vs9.3%,OR:0.43,95CI0.29-0.62,分别)。NDD患者的发病率结果也同样较低。与I/II类相比,ASA分类IV/V与SDD的几率较低(主要:0.9%与3%,OR:0.61,95%CI0.48-0.78;修订:0.9%vs.3%,OR:0.24,95CI0.10-0.55)。
结论:LRYGB修订后早期出院,特别是在过夜之后,可以在精心挑选的患者中安全完成。然而,SDD率仍然很低,限制了其安全性评估。Further,几乎一半的患者在医院住院超过48小时,这表明针对减重手术后门诊管理的政策举措可能不适合该患者人群.
BACKGROUND: Improvements in bariatric surgery outcomes have prompted policy initiatives that explore shifting bariatric surgery toward outpatient procedures. While the safety of early discharge after primary laparoscopic Roux-en-Y gastric bypass (LRYGB) has been reported, its safety for revisional LRYGB remains uncertain. Our study aimed to investigate the safety and patient factors associated with early discharge in patients undergoing revisional LRYGB compared with primary LRYGB.
METHODS: We identified adult patients who underwent primary and revisional LRYGB from 2020 to 2022 in the MBSAQIP database. Patients discharged early, i.e., same-day discharge (SDD) and next-day discharge (NDD) were compared to inpatients. Outcomes included 30-day complications (minor = Clavien-Dindo 1-2; major = Clavien-Dindo 3-4), mortality, readmissions, and reoperations. Multivariable logistic regression models adjusting for patient demographics, comorbidities, and operative time were fitted to assess the study outcomes.
RESULTS: SDD rate was similar after primary (3,422/137,406; 2.5%) and revisional LRYGB (781/32,721; 2.4%), while NDD rate was higher in primary LRYGB (59.8% vs 54.7%, respectively; p < 0.001). SDD patients had lower odds of major complications compared to inpatients following primary (2% vs 7%, aOR: 0.30, 95%CI 0.24-0.38) and revisional LRYGB (3.7% vs 9.3%, aOR: 0.43, 95%CI 0.29-0.62, respectively). NDD patients had similarly lower odds of morbidity outcomes. ASA Classification IV/V was associated with lower odds of SDD compared to Class I/II (Primary: 0.9% vs. 3%, aOR: 0.61, 95% CI 0.48-0.78; Revisions: 0.9% vs. 3%, aOR: 0.24, 95%CI 0.10-0.55).
CONCLUSIONS: Early discharge after revisional LRYGB, particularly after an overnight stay, can be accomplished safely in carefully selected patients. However, SDD rates remain low limiting its safety assessment. Further, almost half of the patients stay more than 48 h in the hospital suggesting that policy initiatives toward outpatient management after bariatric surgery may be inappropriate for this patient population.