背景:纽约大学LangoneHealth拥有三个认可的减肥中心,共有十位不同的减肥外科医生。这项回顾性分析比较了腹腔镜或机器人Roux-en-Y胃旁路术(RYGB)中的个人外科医生技术,以确定与围手术期发病率和死亡率的潜在关联。
方法:通过电子病历和MBSAQIP30天随访数据对2017年至2021年在NYULangone健康校区接受RYGB治疗的所有成年患者进行评估。我们调查了所有十位减肥医生,以分析他们的技术与总不良结局之间的关系。出血,SSI,死亡率,重新接纳,和再次手术通过逻辑回归进行具体亚分析。
结果:711例接受腹腔镜或机器人RYGB的患者中有54例(7.59%)出现不良结局。腹腔镜手术的不良结局较低,先创建JJ吻合术,平面定位,肠系膜的分裂,Covidien™腹腔镜吻合器,金订书钉,单向JJ吻合术,手工缝制普通肠切开术,100厘米的Roux肢体,50厘米的胆胰肢,和常规EGD。较低的出血率观察到与平位,金订书钉,手工缝制普通肠切开术,50厘米的胆胰肢,和常规EGD。在腹腔镜下观察到较低的再入院率,平面定位,Covidien™订书机,单向JJ吻合术,和手工缝制的普通肠切开术。黄金主食的再手术率较低。否则,SSI差异无统计学意义.
结论:减重手术组中RYGB的某些手术技术对总不良结局的发生率有显著影响,出血,重新接纳,再操作。我们的发现值得通过多元回归模型或前瞻性研究设计对上述技术进行进一步研究。
结论:这项研究受限于其回顾性和单变量统计设计的固有性质。我们没有考虑技术之间的相互作用。外科医生的样本量很小,30天的随访时间相对较短。我们没有在模型中包括患者特征或外科医生技能控制。
New York University Langone Health has three accredited bariatric centers, with altogether ten different bariatric surgeons. This retrospective analysis compares individual surgeon techniques in laparoscopic or robotic Roux-en-Y gastric bypass (RYGB) to identify potential associations with perioperative morbidity and mortality.
All adult patients who underwent RYGB between 2017 and 2021 at NYU Langone Health campuses were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. We surveyed all ten practicing bariatric surgeons to analyze the relationship between their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression.
54 (7.59%) out of 711 patients who underwent laparoscopic or robotic RYGB encountered an adverse outcome. Lower adverse outcomes were observed with laparoscopic approach, creating the JJ anastomosis first, flat positioning, division of the mesentery, Covidien™ laparoscopic staplers, gold staples, unidirectional JJ anastomosis, hand-sewn common enterotomy, 100-cm Roux limb, 50-cm biliopancreatic limb, and routine EGD. Lower bleeding rates were observed with flat positioning, gold staples, hand-sewn common enterotomy, 50-cm biliopancreatic limb, and routine EGD. Lower readmission rates were observed in laparoscopic, flat positioning, Covidien™ staplers, unidirectional JJ anastomosis, and hand-sewn common enterotomy. Gold staples had lower reoperation rates. Otherwise, there was no statistically significant difference in SSI.
Certain surgical techniques in RYGB within our bariatric surgery group had significant effects on the rates of total adverse outcomes, bleeding, readmission, and reoperation. Our findings warrant further investigation into the aforementioned techniques via multivariate regression models or prospective study design.
This study was limited by the inherent nature of its retrospective and univariate statistical design. We did not account for the interaction between techniques. The sample size of surgeons was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.