背景:早期小肠梗阻(eSBO)(30天内)是一种罕见但重要的并发症,与高发病率相关,包括重新接纳,再干预,再操作。
目的:确定患者易患eSBO的患者特异性和手术特异性特征,并在术前确定高危个体。
方法:2015-2021代谢和减肥手术认证和质量改进计划(MBSAQIP)。
方法:利用2015-2021MBSAQIPPUF,分析了1,016,484条记录。儿科,修订版,开放转换,以及性别数据不完整的案例,身体质量指数,手术时间,排除30天随访变量。使用Fisher精确和Wilcoxon-Mann-Whitney检验比较病例细节,以识别高危患者。使用罕见事件逻辑回归对eSBO的可能性进行建模。
结果:eSBO的发生率为0.40%。在eSBO的4103次事件中,RYGB(Roux-en-Y型胃旁路术),SG(袖状胃切除术),DS(十二指肠开关)占79.4%,19.3%,和1.3%,分别。许多患者特异性特征与eSBO显著相关。既往前肠手术史,受过非代谢手术训练的操作员,手术时间延长均与eSBO增加相关(P<0.0001)。在同时控制这些因素的同时,与SG相比,DS(OR9.55,P<0.0001)和RYGB(OR5.18,P<0.0001)的eSBO仍然较高。手术时间的增加(OR1.03,P<0.0001)和非MS训练的操作员(OR1.33,P<0.0001)仍然非常重要。男性(OR.70,P<.0001)和糖尿病(OR.78,P<.0001)均具有保护作用。
结论:在迄今为止最大的分析中,eSBO仍然是一个罕见的事件。RYGB在eSBO中所占比例最大,然而,DS具有较高的eSBO风险调整率。
BACKGROUND: Early small bowel obstruction (eSBO) (within 30-days) is a rare but important complication that is associated with high rates of morbidity, including readmission, reintervention, and reoperation.
OBJECTIVE: To identify patient-specific and operation-specific characteristics that predispose patients to eSBO and to identify at-risk individuals preoperatively.
METHODS: 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
METHODS: Utilizing the 2015-2021 MBSAQIP PUF, 1,016,484 records were analyzed. Pediatric, revisional, open-conversion, and cases with incomplete data in sex, body mass index, operative-time, 30-day-follow-up variables were excluded. Case details were compared using Fisher\'s exact & Wilcoxon -Mann -Whitney tests to identify at-risk patients. The likelihood of eSBO was modeled with rare event logistic regression.
RESULTS: Incidence of eSBO was .40%. Of the 4103 occurrences of eSBO, RYGB (Roux-en-Y gastric bypass), SG (sleeve gastrectomy), and DS (duodenal switch) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO. History of prior foregut surgery, a non-metabolic surgery trained operator, and longer operative times were all associated with increased eSBO (P < .0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, P < .0001) and RYGB (OR 5.18, P < .0001) compared to SG. Increased length of operation (OR 1.03, P < .0001) and non -MS-trained operators (OR 1.33, P < .0001) remained highly significant. Male-sex (OR .70, P < .0001) and diabetes (OR .78, P < .0001) were both protective.
CONCLUSIONS: In the largest analysis to date, eSBO remains a rare event. RYGB accounts for the largest proportion of eSBO, however, DS has a higher risk adjusted rate of eSBO.