{"title":"代谢和减肥手术后进行常规上消化道吞咽检查是否能更早诊断出渗漏?","authors":"","doi":"10.1016/j.soard.2024.02.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after </span>bariatric surgery.</p></div><div><h3>Objective</h3><p>To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.</p></div><div><h3>Setting</h3><p>MBSAQIP-accredited hospitals in the United States and Canada.</p></div><div><h3>Methods</h3><p>We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson–Aalen estimator was used to determine the cumulative hazards of leak.</p></div><div><h3>Results</h3><p>In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, <em>P</em> = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, <em>P</em> = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).</p></div><div><h3>Conclusions</h3><p>Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.</p></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?\",\"authors\":\"\",\"doi\":\"10.1016/j.soard.2024.02.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after </span>bariatric surgery.</p></div><div><h3>Objective</h3><p>To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.</p></div><div><h3>Setting</h3><p>MBSAQIP-accredited hospitals in the United States and Canada.</p></div><div><h3>Methods</h3><p>We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson–Aalen estimator was used to determine the cumulative hazards of leak.</p></div><div><h3>Results</h3><p>In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, <em>P</em> = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, <em>P</em> = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).</p></div><div><h3>Conclusions</h3><p>Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.</p></div>\",\"PeriodicalId\":49462,\"journal\":{\"name\":\"Surgery for Obesity and Related Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery for Obesity and Related Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1550728924000777\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery for Obesity and Related Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1550728924000777","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目前还不清楚术后即刻进行的常规上消化道吞咽检查(SS)是否与减肥手术后更早诊断出胃肠漏有关。目的:研究常规上消化道吞咽检查与术后胃肠漏诊断时间之间的关系。研究对象为美国和加拿大通过 MBSAQIP 认证的医院。我们使用 MBSAQIP 2015-2019 数据库对接受腹腔镜初级 Roux-en-Y 胃旁路术 (RYGB) (人数=82510)和袖状胃切除术 (SG) (人数=283520)的成人进行了一项观察性队列研究。使用倾向评分来匹配接受常规SS与未接受常规SS的患者队列。主要结果是诊断漏液的时间。比较了诊断漏液的中位天数。采用 Nelson-Aalen 估计器确定漏液的累积危险度。在我们的研究中,36280 名(23%)RYGB 患者和 135335 名(33%)SG 患者接受了常规 SS 治疗。常规 SS 与更早诊断漏尿无关(RYGB 常规 SS 中位数为 7 [IQR 3-12] 天,而无常规 SS 为 6 [2-11] 天,P=0.9;SG 常规 SS 为 15 [9-22] 天,而无常规 SS 为 14 [8-21] 天,P=0.06),也与更低的漏尿风险无关(RYGB HR 1.0,95%-CI 0.8-1.2;SG HR 1.1,95%-CI 1.0-1.4)。更多常规 SS 患者的住院时间达到或超过 2 天(RYGB 78.3% 对 61.1%;SG 48.6% 对 40.3%)。与不使用常规 SS 相比,常规 SS 与更早诊断出漏损无关。外科医生应考虑放弃常规 SS 的做法,以便更早地诊断出术后渗漏。
Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?
Background
It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after bariatric surgery.
Objective
To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.
Setting
MBSAQIP-accredited hospitals in the United States and Canada.
Methods
We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson–Aalen estimator was used to determine the cumulative hazards of leak.
Results
In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, P = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, P = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).
Conclusions
Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.
期刊介绍:
Surgery for Obesity and Related Diseases (SOARD), The Official Journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Brazilian Society for Bariatric Surgery, is an international journal devoted to the publication of peer-reviewed manuscripts of the highest quality with objective data regarding techniques for the treatment of severe obesity. Articles document the effects of surgically induced weight loss on obesity physiological, psychiatric and social co-morbidities.