Prevalence of Adverse Intraoperative Events during Obesity Surgery and Their Sequelae - 21/07/12
, Abdus S. Wahed, PhD c, Abidemi Adeniji, MS c, Anita P. Courcoulas, MD, MPH, FACS d, Greg Dakin, MD, FACS b, David R. Flum, MD, MPH, FACS e, Vincent Harrison, MD f, James E. Mitchell, MD g, Robert O'Rourke, MD, FACS f, Alfons Pomp, MD, FACS b, John Pender, MD, FACS h, Ramesh Ramanathan, MD d, Bruce M. Wolfe, MD, FACS f
Correspondence address: Alexander J Greenstein, MD, MPH, Department of General Surgery, The Mount Sinai Medical Center, 5 E 98th St, Box 1259, 15th Fl, New York, NY 10029Résumé |
Background |
Adverse intraoperative events (AIEs) during surgery are a well-known entity. A better understanding of the incidence of AIEs and their relationship with outcomes is helpful for surgeon preparation and preoperative patient counseling. The goals of this study are to describe the incidence of AIEs during bariatric surgery and examine their impact on major adverse complications.
Study Design |
The study included 5,882 subjects who had bariatric surgery in the Longitudinal Assessment of Bariatric Surgery study between March 2005 and April 2009. Prospectively collected AIEs included organ injuries, anesthesia-related events, anastomotic revisions, and equipment failure. The relationship between AIEs and a composite end point of 30-day major adverse complications (ie, death, venous thromboembolism, percutaneous, endoscopic, or operative reintervention and failure to be discharged from the hospital within 30 days from surgery) was evaluated using a multivariable relative risk model adjusting for factors known to influence their risk.
Results |
There were 1,608 laparoscopic adjusted gastric banding, 3,770 laparoscopic Roux-en-Y gastric bypass operations, and 504 open Roux-en-Y gastric bypass operations. Adverse intraoperative events occurred in 5% of the overall sample and were most frequent during open Roux-en-Y gastric bypass (7.3%), followed by laparoscopic Roux-en-Y gastric bypass (5.5%) and laparoscopic adjusted gastric banding (3%). The rate of composite end point was 8.8% in the AIE group compared with 3.9% among those without an AIE (p < 0.001). Multivariable analysis revealed that patients with an AIE were at 90% greater risk of composite complication than those without an event (relative risk = 1.90; 95% CI, 1.26−2.88; p = 0.002), independent of the type of procedure (open or laparoscopic).
Conclusions |
Incidence of an AIE is not infrequent during bariatric surgery and is associated with much higher risk of major complication. Additional study is needed to assess the association between specific AIEs and short-term complications.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : AIE, BMI, CE, DVT, LABS, LAGB, LRYGB, ORYGB, PE
Plan
| Disclosure Information: Dr Courcoulas received a research grant from Allergan; Dr Dakin is a paid consultant for Covidien; Dr Flum received a research grant from Covidien; Dr Mitchell received a research grant from Lilly; Dr Pender is a paid consultant and received a research grant from Covidien; and Dr Wolfe is a paid consultant for Allergan. All other authors have nothing to disclose. |
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| This clinical study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Grant numbers: DCC U01 DK066557; Columbia U01-DK66667 (in collaboration with Cornell University Medical Center CTRC, Grant UL1-RR024996); University of Washington U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute U01-DK66471; East Carolina University U01-DK66526; University of Pittsburgh Medical Center U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); and Oregon Health and Science University U01-DK66555. |
Vol 215 - N° 2
P. 271 - août 2012 Retour au numéro
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