Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study
Por:
Sanchez-Santos, R, Corcelles Codina, R, Vilallonga Puy, R, Delgado Rivilla, S, Ferrer Valls, J, Foncillas Corvinos, J, Masdevall Noguera, C, Socas Macias, M, Gomes, P, Balague Ponz, C, De Tomas Palacios, J, Ortiz S, Sanchez-Pernaute, A, Puche Pla, J, Del Castillo Dejardin, D, Abasolo Vega, J, Mans Muntwyler, E, Garcia Navarro, A, Duran Escribano, C, Cassinello Fernandez, N, Perez Climent, N, Gracia Solanas, J, Garcia-Moreno Nisa, F, Hernandez Matias, A, Valenti Azcarate, V, Perez Folques, J, Navarro Garcia, I, Dominguez-Adame Lanuza, E, Martinez Cortijo, S and Gonzalez Fernandez, J
Publicada:
1 dic 2016
Resumen:
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).
Filiaciones:
Sanchez-Santos, R:
Complejo Hosp Univ Pontevedra, Soc Espanola Cirugia Obesidad & Enfermedades Meta, Pontevedra, Spain
Corcelles Codina, R:
Hosp Clin Barcelona, Barcelona, Spain
Vilallonga Puy, R:
Hosp Univ ValldHebron, Barcelona, Spain
Delgado Rivilla, S:
Hosp Clin Barcelona, Barcelona, Spain
Ferrer Valls, J:
Clin Obesitas, Valencia, Spain
Foncillas Corvinos, J:
Quiron Salud Hosp Univ Sagrat Cor, Barcelona, Spain
Masdevall Noguera, C:
Hosp Univ Sagrat Cor, Barcelona, Spain
Socas Macias, M:
Hosp Univ Virgen del Rocio, Seville, Spain
Gomes, P:
Ctr Hosp Univ Coimbra, Hosp Geral, Coimbra, Portugal
Balague Ponz, C:
Hosp St Pau UAB, Barcelona, Spain
De Tomas Palacios, J:
Hosp Gregorio Maranon, Madrid, Spain
Ortiz S:
Hosp Gen Alicante, Alicante, Spain
Sanchez-Pernaute, A:
Hosp Clin San Carlos, Madrid, Spain
Puche Pla, J:
Hosp Gen Univ Valencia, Valencia, Spain
Del Castillo Dejardin, D:
Hosp Univ Reus, Tarragona, Spain
Abasolo Vega, J:
Hosp Basurto, Bilbao, Spain
Mans Muntwyler, E:
Hosp Mataro, Mataro, Spain
Garcia Navarro, A:
Hosp Virgen de las Nieves, Granada, Spain
Duran Escribano, C:
Hosp Virgen de la Paloma, Madrid, Spain
Cassinello Fernandez, N:
Hosp Clin Univ Valencia, Valencia, Spain
:
Hosp Virgen de los Lirios, Alcoy, Spain
Gracia Solanas, J:
Hosp Clin Zaragoza, Zaragoza, Spain
Garcia-Moreno Nisa, F:
Hosp Ramon & Cajal, Madrid, Spain
Hernandez Matias, A:
Hosp Univ Getafe Getafe, Madrid, Spain
Valenti Azcarate, V:
Univ Navarra Clin, Pamplona, Spain
Perez Folques, J:
Hosp Virgen del Castillo Yecla, Murcia, Spain
Navarro Garcia, I:
Hosp Santa Lucia Cartagena, Cartagena, Spain
Dominguez-Adame Lanuza, E:
Hosp Univ Virgen Macarena, Seville, Spain
Martinez Cortijo, S:
Hosp Talavera de la Reina, Talavera De La Reina, Spain
Gonzalez Fernandez, J:
Ctr Med Asturias, Oviedo, Spain
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