Analysis of bleeding characteristics and influencing factors after bariatric surgery / 中华消化外科杂志

Objective:To investigate the bleeding characteristic and influencing factors after bariatric surgery.Methods:The retrospective case-control study was conducted. The clinical data of 3 371 patients with obesity who underwent bariatric surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 903 males and 2 468 females, aged 31(16?65)years. Observation indicators: (1) occurrence, diagnosis and treatment of bleeding after bariatric surgery; (2) analysis of influencing factors for bleeding after bariatric surgery. (3) Follow-up. Follow-up was conducted through outpatient examinations, telephone interview or WeChat to detect total weight loss rate, resolution of hypertension and remission of type 2 diabetes of the patients with bleeding after bariatric surgery. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. Ordinal data were analzyed by the non-parametric rank sum test. Univariate analysis was conducted using the corresponding statistical methods based on data type. The binary Logistic regression was used for multivariate analysis. Results:(1) Occurrence, diagnosis and treatment of bleeding after bariatric surgery. There were 27 of 3 371 patients diagnosed with postoperative bleeding, including 13 males and 14 females. There were 18 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding. Among the 27 patients with postoperative bleeding, 8 cases were diagnosed with bleeding on the day after operation, 13 cases were diagnosed on the first day after operation, 4 casess were diagnosed on the second day, and 2 cases were diagnosed on the third day or later. Among the 27 patients with postoperative bleeding, 24 cases had tachycardia as the main clinical manifestation, 11 patients had abnormal abdominal drainage with the drainage volume as 300(range, 100?600)mL, 6 cases had hematocheziain with the volume as 500(range, 120?1 000)mL, 5 cases were manifested as hypotension, 3 cases had hematemesis with the volume as 300(range, 50?800)mL, 2 cases had a significant decrease in hemoglobin on the first day after operation. One patient may have multiple clinical manifestations. Among the 27 patients with postoperative bleeding, 6 cases with abdominal bleeding received emergency laparotomy due to continuous increase of abdominal drainage or hemorrhagic shock, of which one patient died of heart failure after emergency reoperation. The time between primary and secondary operation was 13.5(range, 2.0?45.0)hours, and the volume of blood accumulation was 1 000(range, 600?7 000)mL. The bleeding sites were identified in 5 patients during reoperation, including 2 cases of staple line bleeding after sleeve gastrectomy, 1 case of lesser sac bleeding after Roux-en-Y gastric bypass, 1 case of short gastric vessel bleeding and 1 case of trocar site bleeding. One patient had no obvious active bleeding during reoperation. The remaining 12 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding were treated by conservative therapy. The duration of bleeding lasted for (2.1±0.7)days. (2) Analysis of influencing factors for bleeding after bariatric surgery. Results of univariate analysis showed that gender, hypertension, type 2 diabetes, surgical type were the related factors that affected the bleeding after bariatric surgery ( χ2=6.33, 42.16, 4.49, 14.09, P<0.05). Results of multivariate analysis indicated that surgical type was a independent factor affecting postoperative bleeding in patients undergoing bariatric surgery ( odds ratio=1.69, 95% confidence interval as 1.18?2.41, P<0.05). (3) Follow-up. All the 27 patients were followed up for 16(1?62)months. Eighteen patients reached or exceeded the 12 months follow-up time point. The 1-year total weight loss rate was 36%±12%, the resolution proportion of hypertension was 8/11, and the complete remission proportion of type 2 diabetes was 6/7. Six patients reached or exceeded the 36 months follow-up time point. The 3-year total weight loss rate was 35%±12%, the resolution proportion of hypertension was 4/5, and the complete remission proportion of type 2 diabetes was 1/1. Conclusions:The incidence of post-operative bleeding after bariatric surgery is low. Tachycardia, abnormal abdominal drainage and hypotension have sentinel functions. Surgical type is a independent factor affecting bleeding after bariatric surgery.

Depression,anxiety and their effects on quality of life before metabolic surgery in obese patients / 中国实用护理杂志

Objective To investigate the status of depression/anxiety in obese patients seeking metabolic surgery and analyze the effects of depression/anxiety on different aspects of quality of life. Methods Convenient sampling was used and 117 metabolic surgery were recruited from the Department of Bariatric and Metabolic Surgery in the First Affiliated Hospital of Nanjing Medical University from March to July,2017. Patient Health Questionnaire(PHQ-9),Generalized Anxiety Disorder 7-item scale (GAD-7),12 item Short-Form Health Survey(SF-12)and the general information and disease characteristics questionnaire were used to collect data. Results Nearly 25.6%(30/117) of the patients suffered from moderate, moderately severe and severe depression symptoms and the median and interquartile range of PHQ-9 was 6 and 7 points.16.2%(19/117)of the patients had moderate and severe anxiety symptoms and the median and interquartile range of GAD-7 was 3 and 6 points. Multiple linear regression analysis showed that scores in the physical component of the SF-12 were associated with the body mass index,the presence of comorbidities and depression,which could explain 20.0% of the total variance;the symptoms of depression and anxiety were negatively related to the mental component summary of SF-12,which could explain 49.6% of the total variance. Conclusions The present findings suggests that there is a high occurrence of depression and anxiety in metabolic surgery patients, which severely impair the patients′quality of life. As for the obese patients seeking metabolic surgery for treatment, routine screening of depression and anxiety incorporating the diagnosis of the problems are warranted.Then intervention based on the assessment can be exerted to maximize the benefit of patients undergoing the surgery in the long term.

Clinical features and risk factors analysis of 30-day readmission after bariatric and metabolic surgery / 中华消化外科杂志

Objective To explore the incidence,clinical features,causes,treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery.Methods The retrospective case-control study was conducted.The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected.All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016.Observation indicators:(1) 30-day readmission situations after bariatric and metabolic surgery:cases with readmission,readmission time,clinical features,causes and treatment of readmission;(2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Thirty-day readmission situations after bariatric and metabolic surgery:among 631 patients receiving postoperative 1-months follow-up,21 had 30-day readmission,with an incidence of 3.33％ (21/631),including 13 males and 8 females;10 received LSG and 11 received LRYGB.The median readmission time of 21 patients was 12 days (range,4-30 days).Of 21 patients,nausea,vomiting and dehydration of the main manifestations were detected in 11 patients,gastrointestinal bleeding in 6 patients,high fever in 2 patients,bowel obstruction in 1 patient and abdominal pain in 1 patient.The causes of the readmission of 21 patients:8 had improper food intake including 5 with premature solid food intake,1 with premature semi-fluid food intake,1 with irritating food intake and 1 with swallowing whole tablets;3 had postoperative over-anxiety;1 had Petersen hiatal hernia;1 had anastomotic ulcer;1 had anastomotic edema;1 had abdominal abscess.Of 6 patients with uncertain causes,4 had gastrointestinal bleeding and didn't receive endoscopy;1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy,showing no trouble finding;1 had high fever,and no abnormality was detected by imaging examination.Of 21 patients,19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement,without readmission;1 with abdominal abscess was cured after emergency debridement and drainage;1 with Petersen hiatal hernia was cured by emergency surgery.The median duration of hospital stay in 21 patients with readmission was 7 days (range,3-40 days).(2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery:the results of univariate analysis showed that gender,preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (x2 =5.330,6.498,4.574,P＜0.05).The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489,2.912,95％ confidence interval:1.006-6.161,1.196-7.088,P＜0.05).Conclusions Nausea,vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery,and it might be associated with improper food intake.Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery.

Implementation of enhanced recovery after surgery in nutritional management of patients undergoing metabolic surgery / 中华胃肠外科杂志

Metabolic surgery is a gastrointestinal surgical procedure to treat obesity and its related co-morbidities with rapid development in recent years. Patients undergoing metabolic surgery have preoperative nutritional disorders, and the nutrition management for these patients is the key point of perioperative management. During the perioperative period, current research has preliminarily confirmed that perioperative managements including supplementation of micronutrients, preoperative evaluation of the weight loss, preoperative fasting and carbohydrate oral intake based on the full application of ERAS and characteristics of the patients undergoing metabolic surgery, are safe and effective in clinical practice. As for the postoperative diet strategy, current literature remains non-unified to identify the duration and the content of the nutrition managements. Domestic clinical reports about the postoperative nutrition managements after metabolic surgery are rare and lack of unified and good reference standard. Meanwhile, divergence still existed in current literature regarding to the content of the postoperative nutrition managements. Therefore, it is necessary to develop the standardized protocol for nutrition managements which is offering basis and reference for the clinical application of perioperative nutrition managements after metabolic surgery.

Design and results of preoperative questionnaire in bariatric surgery / 中国实用护理杂志

Objective To design an appropriate preoperative questionnaire in Chinese bariatric surgery.Methods Bariatric surgery center carried out laparoscopic bariatric operation from January 2010,preoperative questionnaire before the operation were supplied.Till January 2014,a total of 401 patients replied to the survey.The questionnaires were designed through three stages:translated from the Cleveland Clinic (USA) and applied in 30 patients for the first survey; adjustments and changes to the contents of the questionnaire for 90 patients according to Chinese conditions in the second phase; in the third stage,the third edition questionnaire was used in 281 patients.The satisfaction degree of the doctors and patients about the content of the questionnaire was evaluated.Results For the three versions of the questionnaire,the doctor satisfaction rate was 73.3％,86.7％ and 96.8％.Patients' satisfaction rate of three versions were 30.0％,40.0％,76.9％,not satisfactory rate was 20.0％,11.1％,2.8％.Conclusions The current preoperative questionnaire includes 11 categories with 101 items of the third edition,doctors and patients satisfaction rate is higher,and it is suitable for Chinese bariatric surgery.