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Tytuł pozycji:

Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study.

Tytuł:
Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study.
Autorzy:
Kauppila JH; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.; Surgery Research Unit, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu.
Santoni G; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Tao W; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Lynge E; Department of Public Health, University of Copenhagen, Denmark.
Koivukangas V; Surgery Research Unit, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu.
Tryggvadóttir L; Icelandic Cancer Registry, Icelandic Cancer Society.; Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland.
Ness-Jensen E; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Romundstad P; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Pukkala E; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki.; Faculty of Social Sciences, Tampere University, Tampere, Finland.
von Euler-Chelpin M; Department of Public Health, University of Copenhagen, Denmark.
Lagergren J; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.; School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, UK.
Źródło:
The British journal of surgery [Br J Surg] 2020 Aug; Vol. 107 (9), pp. 1221-1230. Date of Electronic Publication: 2020 Apr 01.
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Publication: 2021- : [Oxford] : Oxford University Press
Original Publication: [Bristol, England : Baltimore : John Wright & Sons ; Williams & Wilkins Co.
MeSH Terms:
Bariatric Surgery/*mortality
Reoperation/*statistics & numerical data
Adult ; Age Factors ; Bariatric Surgery/adverse effects ; Comorbidity ; Female ; Humans ; Incidence ; Laparoscopy/adverse effects ; Laparoscopy/mortality ; Laparoscopy/statistics & numerical data ; Male ; Middle Aged ; Proportional Hazards Models ; Registries ; Risk Factors ; Scandinavian and Nordic Countries/epidemiology ; Time Factors
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Grant Information:
140322 Cancerfonden; 154860 Nordic Cancer Union; D0547801 Vetenskapsrådet
Contributed Indexing:
Local Abstract: [Publisher, Spanish; Castilian] La cirugía bariátrica conlleva un riesgo de complicaciones postoperatorias graves, que algunas veces ocasionan reintervenciones o incluso son causa de mortalidad. La incidencia y los factores de riesgo de reinterveniones y mortalidad a los 90 días tras cirugía bariátrica no están claros, y fueron examinados en este estudio. MÉTODOS: Todos los pacientes que fueron sometidos a cirugía bariátrica en uno de los cinco países nórdicos en 1980-2012 fueron incluidos en un estudio de cohortes de base poblacional. Los datos de los procedimientos quirúrgicos y endoscópicos, diagnóstico, y mortalidad se obtuvieron a partir de registros nacionales completos y de alta calidad. Mediante una regresión de Cox multivariable se obtuvieron los cocientes de riesgos instantáneos (hazard ratios, HR) y los intervalos de confianza 95% (i.c. del 95%) ajustados por país, edad, sexo, comorbilidad, y tipo, abordaje, año y volumen de casos de cirugía bariátrica del hospital. [Publisher, Spanish; Castilian] De un total de 49.977 pacientes, 1.111 (2,2%) precisaron una reintervención y 95 (0,2%) fallecieron durante los primeros 90 días tras la cirugía bariátrica. Los factores de riesgo para el resultado compuesto reintervención/mortalidad fueron la edad avanzada (HR = 1,7 (i.c. del 95% 1,4-2,0) edad ≥ 50 versus < 30 años)) y la comorbilidad (HR = 2,7 (i.c. del 95% 1,5-4,6) puntuación del índice de comorbilidad de Charlson ≥ 2 versus 0)). Se observó una disminución de los HRs tras la gastroplastia vertical con banda en comparación con el bypass gástrico (HR = 0,4, (i.c. del 95% 0,3-0,5)) y el periodo de estudio más reciente (HR = 0,5 (i.c. del 95% 0,4-0,7) ≥ 2010 versus < 2000)). El sexo, el abordaje quirúrgico laparoscópico versus abierto y el volumen del hospital no influyeron sobre el riesgo de reintervención/mortalidad, pero la cirugía laparoscópica se asoció con una mortalidad a los 90 días más baja (HR 0,3, i.c. del 95% 0,2-0,5). CONCLUSIÓN: La reintervención y la mortalidad son eventos infrecuentes durante los primeros 90 días tras la cirugía bariátrica, incluso en esta cohorte nacional y no seleccionada de cinco paises. Los pacientes mayores con comorbilidades tienen un riesgo relativo aumentado de reintervención y mortalidad.
Entry Date(s):
Date Created: 20200403 Date Completed: 20210222 Latest Revision: 20210222
Update Code:
20240105
DOI:
10.1002/bjs.11533
PMID:
32239499
Czasopismo naukowe
Background: Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study.
Methods: This population-based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high-quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co-morbidity, type of surgery and approach, year and hospital volume of bariatric surgery.
Results: Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co-morbidity (HR 2·66, 1·53 to 4·62, for Charlson co-morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90-day mortality (HR 0·29, 0·16 to 0·53).
Conclusion: Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co-morbidities have an increased relative risk of these outcomes.
(© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)
Comment in: Br J Surg. 2020 Aug;107(9):e350. (PMID: 32497245)
Comment in: Br J Surg. 2020 Aug;107(9):e349. (PMID: 32497301)

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