Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study
Sánchez-Santos R (1), Corcelles Codina R (2), Vilallonga Puy R (3), Delgado Rivilla S (2), Ferrer Valls JV (4), Foncillas Corvinos J (5), Masdevall Noguera C (6), Socas Macias M (7), Gomes P (8), Balague Ponz C (9), De Tomas Palacios J (10), Ortiz Sebastian S (11), Sanchez-Pernaute A (12), Puche Pla JJ (13), Del Castillo Dejardin D (14), Abasolo Vega J (15), Mans Muntwyler E (16), Garcia Navarro A (17(, Duran Escribano C (18), Cassinello Fernández N (19), Perez Climent N (20), Gracia Solanas JA (21), Garcia-Moreno Nisa F (22), Hernández Matias A (23), Valentí Azcarate V (24), Perez Folques JE (25), Navarro Garcia I (26), Dominguez-Adame Lanuza E (27), Martinez Cortijo S (28), González Fernández J (29).
(1) Sociedad Española de Cirugía de la Obesidad y Enfermedades Metabólicas, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain. firstname.lastname@example.org.
(2) Hospital Clinic de Barcelona, Barcelona, Spain.
(3) Hospital Universitario Valld´Hebron, Barcelona, Spain.
(4) Clinica Obesitas, Valencia, Spain.
(5) Quiron Salud-Hospital Universitari Sagrat Cor, Barcelona, Spain.
(6) Hospital Universitari Sagrat Cor, Barcelona, Spain.
(7) Hospital Universitario Virgen del Rocio, Sevilla, Spain.
(8) Hospital Geral, Centro Hospitalar Univertario Coimbra, Coimbra, Portugal.
(9) Hospital Sant Pau UAB, Barcelona, Spain.
(10) Hospital Gregorio Marañon, Madrid, Spain.
(11) Hospital General de Alicante, Alicante, Spain.
(12) Hospital Clinico San Carlos, Madrid, Spain.
(13) Hospital General Universitario de Valencia, Valencia, Spain.
(14) Hospital Universitario de Reus, Tarragona, Spain.
(15) Hospital de Basurto, Bilbao, Spain.
(16) Hospital de Mataró, Mataró, Spain.
(17) Hospital Virgen de las Nieves, Granada, Spain.
(18) Hospital Virgen de la Paloma, Madrid, Spain.
(19) Hospital Clinico Universitario de Valencia, Valencia, Spain.
(20)Hospital Virgen de los Lirios, Alcoy, Spain.
(21)Hospital Clínico de Zaragoza, Zaragoza, Spain.
(22)Hospital Ramón y Cajal, Madrid, Spain.
(23)Hospital Universitario de Getafe. Getafe, Madrid, Spain.
(24)Clinica Universitaria de Navarra, Pamplona, Spain.
(25)Hospital Virgen del Castillo. Yecla, Murcia, Spain.
(26)Hospital Santa Lucia Cartagena, Cartagena, Spain.
(27)Hospital Universitario Virgen Macarena, Sevilla, Spain.
(28)Hospital de Talavera de la Reina, Talavera de la Reina, Spain.
(29)Centro Médico Asturias, Oviedo, Spain.
Magazine: Obesity Surgery
Date: May 19, 2016General and Digestive Surgery Obesity Unit
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.
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.
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).
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).
CITATION Obes Surg. 2016 May 19
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