目的:Roux-en-Y胃旁路术(RYGB)后的边缘性溃疡(MU)是一种既定的并发症,与早期的MU(手术后30天内)相比,人们对其了解较少。这项研究旨在确定接受原发性RYGB的患者早期MU的危险因素。
方法:利用代谢和减肥手术认证质量改进项目(MBSAQIP2015-2021)的数据,评估了1,346,468条记录。在修订的排除之后,转换,儿科病例,非二元性别,缺失体重指数(BMI)数据,和缺少手术时间;纳入291,625例原发性RYGB,用于早期MU的全面分析和罕见事件建模。
结果:早期MU的患病率为0.29%(n=850)。早期MU的较高比率与BMI相关,种族,糖尿病(DM)病史,既往血栓并发症(深静脉血栓形成(DVT)和肺栓塞(PE)),既往经皮心脏介入治疗(PTC),免疫抑制治疗,和抗凝状态。此外,手术方面,例如外科医生的非专业化和更长的手术时间也与更高的早期MU率相关。罕见事件回归建模注意到早期MU与年轻年龄显著相关,需要胰岛素的糖尿病,PTC的历史,DVT,免疫抑制治疗,和抗凝状态。
结论:早期MU仍然是一种相对罕见的并发症。低于先前报道的发生率表明患者准备和手术技术都可能有所改善。相关危险因素的识别可以更好地对有早期MU风险的患者进行围手术期和术中管理。
OBJECTIVE: Marginal ulceration (MU) following Roux-en-Y gastric bypass (
RYGB) is an established complication, with early MU (within 30-days of operation) being less understood compared to its late counterpart. This study aims to identify risk factors for early MU in patients undergoing primary
RYGB.
METHODS: Utilizing data from the Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP 2015-2021), 1,346,468 records were evaluated. After exclusions for revisions, conversions, pediatric cases, nonbinary gender, missing body mass index (BMI) data, and missing operative time; 291,625 cases of primary
RYGB were included for full analysis and rare events modeling of early MU.
RESULTS: The prevalence of early MU was .29% (n = 850). Higher rates of early MU were associated with BMI, race, history of diabetes mellitus (DM), prior thrombotic complications (deep vein thrombosis (DVT) and pulmonary embolism (PE)), prior percutaneous cardiac intervention (PTC), immunosuppressive therapy, and anticoagulation status. Additionally, procedural aspects like the nonspecialization of the surgeon and longer operative times also correlated with higher early MU rates. Rare-events regression modeling noted significant associations of early MU with younger age, diabetes requiring insulin, history of PTC, DVT, immunosuppressive therapy, and anticoagulation status.
CONCLUSIONS: Early MU remains a relatively rare complication. The lower than previously reported occurrence suggests possible improvements in both patient preparation and surgical technique. The identification of relevant risk factors enables better perioperative and intraoperative management of patients at risk of developing early MU.