title: Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study.
abstract: 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).
authors.affiliation: Sociedad Española de Cirugía de la Obesidad y Enfermedades Metabólicas, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain. raquelsanchezsantos@gmail.com.
authors.forename: Raquel
authors.initials: R
authors.lastname: Sánchez-Santos
authors.affiliation: Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles Codina
authors.affiliation: Hospital Universitario Valld´Hebron, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Vilallonga Puy
authors.affiliation: Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Salvadora
authors.initials: S
authors.lastname: Delgado Rivilla
authors.affiliation: Clinica Obesitas, Valencia, Spain.
authors.forename: Jose Vicente
authors.initials: JV
authors.lastname: Ferrer Valls
authors.affiliation: Quiron Salud-Hospital Universitari Sagrat Cor, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Foncillas Corvinos
authors.affiliation: Hospital Universitari Sagrat Cor, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Masdevall Noguera
authors.affiliation: Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Socas Macias
authors.affiliation: Hospital Geral, Centro Hospitalar Univertario Coimbra, Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gomes
authors.affiliation: Hospital Sant Pau UAB, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague Ponz
authors.affiliation: Hospital Gregorio Marañon, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: De Tomas Palacios
authors.affiliation: Hospital General de Alicante, Alicante, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ortiz Sebastian
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Sanchez-Pernaute
authors.affiliation: Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Jose Julian
authors.initials: JJ
authors.lastname: Puche Pla
authors.affiliation: Hospital Universitario de Reus, Tarragona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Del Castillo Dejardin
authors.affiliation: Hospital de Basurto, Bilbao, Spain.
authors.forename: Julen
authors.initials: J
authors.lastname: Abasolo Vega
authors.affiliation: Hospital de Mataró, Mataró, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Mans Muntwyler
authors.affiliation: Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia Navarro
authors.affiliation: Hospital Virgen de la Paloma, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Duran Escribano
authors.affiliation: Hospital Clinico Universitario de Valencia, Valencia, Spain.
authors.forename: Norberto
authors.initials: N
authors.lastname: Cassinello Fernández
authors.affiliation: Hospital Virgen de los Lirios, Alcoy, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Perez Climent
authors.affiliation: Hospital Clínico de Zaragoza, Zaragoza, Spain.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Gracia Solanas
authors.affiliation: Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Garcia-Moreno Nisa
authors.affiliation: Hospital Universitario de Getafe. Getafe, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernández Matias
authors.affiliation: Clinica Universitaria de Navarra, Pamplona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Valentí Azcarate
authors.affiliation: Hospital Virgen del Castillo. Yecla, Murcia, Spain.
authors.forename: Jose Eduardo
authors.initials: JE
authors.lastname: Perez Folques
authors.affiliation: Hospital Santa Lucia Cartagena, Cartagena, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Navarro Garcia
authors.affiliation: Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Dominguez-Adame Lanuza
authors.affiliation: Hospital de Talavera de la Reina, Talavera de la Reina, Spain.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Martinez Cortijo
authors.affiliation: Centro Médico Asturias, Oviedo, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: González Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000193:education / Q000401:mortality* / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education / Q000401:mortality / Q000706:statistics & numerical data; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D011174:Portugal / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Learning curve; Mortality; Prognostic factors; Sleeve gastrectomy