Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sánchez-Santos Raquel, Corcelles Codina Ricard, Vilallonga Puy Ramon, Delgado Rivilla Salvadora, Ferrer Valls Jose Vicente, Foncillas Corvinos Javier, Masdevall Noguera Carlos, Socas Macias Maria, Gomes Pedro, Balague Ponz Carmen, De Tomas Palacios Jorge, Ortiz Sebastian Sergio, Sanchez-Pernaute Andres, Puche Pla Jose Julian, Del Castillo Dejardin Daniel, Abasolo Vega Julen, Mans Muntwyler Ester, Garcia Navarro Ana, Duran Escribano Carlos, Cassinello Fernández Norberto, Perez Climent Nieves, Gracia Solanas Jose Antonio, Garcia-Moreno Nisa Francisca, Hernández Matias Alberto, Valentí Azcarate Victor, Perez Folques Jose Eduardo, Navarro Garcia Inmaculada, Dominguez-Adame Lanuza Eduardo, Martinez Cortijo Sagrario, González Fernández Jesus
Аннотация
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).