TY - JOUR
T1 - Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study
AU - Sánchez-Santos, Raquel
AU - Corcelles Codina, Ricard
AU - Vilallonga Puy, Ramon
AU - Delgado Rivilla, Salvadora
AU - Ferrer Valls, Jose Vicente
AU - Foncillas Corvinos, Javier
AU - Masdevall Noguera, Carlos
AU - Socas Macias, Maria
AU - Gomes, Pedro
AU - Balague Ponz, Carmen
AU - De Tomas Palacios, Jorge
AU - Ortiz Sebastian, Sergio
AU - Sanchez-Pernaute, Andres
AU - puche Pla, Jose Julian
AU - Del Castillo Dejardin, Daniel
AU - Abasolo Vega, Julen
AU - Mans Muntwyler, Ester
AU - Garcia Navarro, Ana
AU - Duran Escribano, Carlos
AU - Cassinello Fernández, Norberto
AU - Perez Climent, Nieves
AU - Gracia Solanas, Jose Antonio
AU - Garcia-Moreno Nisa, Francisca
AU - Hernández Matias, Alberto
AU - Valentí Azcarate, Victor
AU - Perez Folques, Jose Eduardo
AU - Navarro Garcia, Inmaculada
AU - Dominguez-Adame Lanuza, Eduardo
AU - Martinez Cortijo, Sagrario
AU - González Fernández, Jesus
PY - 2016/12/1
Y1 - 2016/12/1
N2 - © 2016, Springer Science+Business Media New York. 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).
AB - © 2016, Springer Science+Business Media New York. 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).
KW - Complications
KW - Learning curve
KW - Mortality
KW - Prognostic factors
KW - Sleeve gastrectomy
U2 - 10.1007/s11695-016-2229-6
DO - 10.1007/s11695-016-2229-6
M3 - Article
SN - 0960-8923
VL - 26
SP - 2829
EP - 2836
JO - Obesity Surgery
JF - Obesity Surgery
IS - 12
ER -
