Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study.

Autor: Sánchez-Santos R; Sociedad Española de Cirugía de la Obesidad y Enfermedades Metabólicas, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain. raquelsanchezsantos@gmail.com., Corcelles Codina R; Hospital Clinic de Barcelona, Barcelona, Spain., Vilallonga Puy R; Hospital Universitario Valld´Hebron, Barcelona, Spain., Delgado Rivilla S; Hospital Clinic de Barcelona, Barcelona, Spain., Ferrer Valls JV; Clinica Obesitas, Valencia, Spain., Foncillas Corvinos J; Quiron Salud-Hospital Universitari Sagrat Cor, Barcelona, Spain., Masdevall Noguera C; Hospital Universitari Sagrat Cor, Barcelona, Spain., Socas Macias M; Hospital Universitario Virgen del Rocio, Sevilla, Spain., Gomes P; Hospital Geral, Centro Hospitalar Univertario Coimbra, Coimbra, Portugal., Balague Ponz C; Hospital Sant Pau UAB, Barcelona, Spain., De Tomas Palacios J; Hospital Gregorio Marañon, Madrid, Spain., Ortiz Sebastian S; Hospital General de Alicante, Alicante, Spain., Sanchez-Pernaute A; Hospital Clinico San Carlos, Madrid, Spain., Puche Pla JJ; Hospital General Universitario de Valencia, Valencia, Spain., Del Castillo Dejardin D; Hospital Universitario de Reus, Tarragona, Spain., Abasolo Vega J; Hospital de Basurto, Bilbao, Spain., Mans Muntwyler E; Hospital de Mataró, Mataró, Spain., Garcia Navarro A; Hospital Virgen de las Nieves, Granada, Spain., Duran Escribano C; Hospital Virgen de la Paloma, Madrid, Spain., Cassinello Fernández N; Hospital Clinico Universitario de Valencia, Valencia, Spain., Perez Climent N; Hospital Virgen de los Lirios, Alcoy, Spain., Gracia Solanas JA; Hospital Clínico de Zaragoza, Zaragoza, Spain., Garcia-Moreno Nisa F; Hospital Ramón y Cajal, Madrid, Spain., Hernández Matias A; Hospital Universitario de Getafe. Getafe, Madrid, Spain., Valentí Azcarate V; Clinica Universitaria de Navarra, Pamplona, Spain., Perez Folques JE; Hospital Virgen del Castillo. Yecla, Murcia, Spain., Navarro Garcia I; Hospital Santa Lucia Cartagena, Cartagena, Spain., Dominguez-Adame Lanuza E; Hospital Universitario Virgen Macarena, Sevilla, Spain., Martinez Cortijo S; Hospital de Talavera de la Reina, Talavera de la Reina, Spain., González Fernández J; Centro Médico Asturias, Oviedo, Spain.
Jazyk: angličtina
Zdroj: Obesity surgery [Obes Surg] 2016 Dec; Vol. 26 (12), pp. 2829-2836.
DOI: 10.1007/s11695-016-2229-6
Abstrakt: Background: Complications in sleeve gastrectomy (SG) can cast a shadow over the technique's good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety.
Methods: A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death.
Results: The following data were collected for 2882 patients: age, 43.85 ± 11.6. 32.9 % male; BMI 47.22 ± 8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre ≥40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon's experience < 20 patients, OR 1.72 (1.32-2.25); experience > 100 patients, OR 0.78 (0.69-0.87); DM2, OR1.48(1.12-1.95); probe > 40 F, OR 0.613 (0.429-0.876). Leak RFs were the following: smoking, OR1.93 (1.1-3.41); surgeon's experience < 20 patients, OR 2.4 (1.46-4.16); experience of 20-50 patients, OR 2.5 (1.3-4.86); experience >100 patients, OR 0.265 (0.11-0.63); distance to pylorus > 4 cm, OR 0.510 (0.29-0.91). RFs for death were as follows: smoking, OR 8.64 (2.63-28.34); DM2, OR 3.25 (1.1-9.99); distance to pylorus < 5 cm, OR 6.62 (1.63-27.02).
Conclusions: The safety of SG may be compromised by nonmodifiable factors such as age >65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size <40 F, distance to the pylorus <4 cm, and the surgeon's experience (<50-100 cases).
Databáze: MEDLINE
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