Dindo Daniel, Muller Markus K, Weber Markus, Clavien Pierre-Alain
Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Lancet. 2003 Jun 14;361(9374):2032-5. doi: 10.1016/S0140-6736(03)13640-9.
Obese patients are generally believed to be at a higher risk for surgery than those who are not obese, although convincing data are lacking.
We prospectively investigated a cohort of 6336 patients undergoing general elective surgery at our institution to assess whether obesity affects the outcome of surgery. Exclusion criteria were emergency, vascular, thoracic, and bariatric operations; transplantation procedures; patients under immunosuppression; and operations done under local anaesthesia. Postoperative morbidity was analysed for non-obese and obese patients (body-mass index <30 kg/m(2) vs >or=30 kg/m(2)). Obesity was further stratified into mild obesity (30.0-34.9 kg/m(2)) and severe obesity (>or=35 kg/m(2)). Risk factors were analysed with univariate and multivariate models.
The cohort consisted of 6336 patients, of whom 808 (13%) were obese, 569 (9%) were mildly obese, and 239 (4%) had severe obesity. The morbidity rates in patients who were obese compared with those who were not were much the same (122 [15.1%] of 808 vs 901 [16.3%] of 5528; p=0.26), with the exception of an increased incidence of wound infections after open surgery in patients who were obese (17 [4%] of 431 vs 92 [3%] of 3555, p=0.03). Incidence of complications did not differ between patients who were mildly obese (91 [16.0%] of 569), severely obese (36 [15.1%] of 239), and non-obese (901 [16.3%] of 5528; p=0.19). In multivariate regression analyses, obesity was not a risk factor for development of postoperative complications. Of note, the additional medical resource use as estimated by a new classification of complications showed no differences between patients who were and were not obese.
Obesity alone is not a risk factor for postoperative complications. The regressive attitude towards general surgery in obese patients is no longer justified.
尽管缺乏令人信服的数据，但一般认为肥胖患者手术风险高于非肥胖患者。
我们前瞻性地调查了在我院接受普通择期手术的6336例患者，以评估肥胖是否会影响手术结果。排除标准包括急诊手术、血管手术、胸科手术和减肥手术；移植手术；免疫抑制患者；以及局部麻醉下进行的手术。分析了非肥胖和肥胖患者（体重指数<30 kg/m²与≥30 kg/m²）的术后发病率。肥胖进一步分为轻度肥胖（30.0 - 34.9 kg/m²）和重度肥胖（≥35 kg/m²）。采用单因素和多因素模型分析危险因素。
该队列包括6336例患者，其中808例（13%）肥胖，569例（9%）轻度肥胖，239例（4%）重度肥胖。肥胖患者与非肥胖患者的发病率大致相同（808例中的122例[15.1%]对5528例中的901例[16.3%]；p = 0.26），但肥胖患者开放手术后伤口感染发生率增加（431例中的17例[4%]对3555例中的92例[3%]，p = 0.03）。轻度肥胖患者（569例中的91例[16.0%]）、重度肥胖患者（239例中的36例[15.1%]）和非肥胖患者（5528例中的901例[16.3%]）的并发症发生率无差异（p = 0.19）。在多因素回归分析中，肥胖不是术后并发症发生的危险因素。值得注意的是，根据新的并发症分类估计的额外医疗资源使用在肥胖患者和非肥胖患者之间没有差异。
单纯肥胖不是术后并发症的危险因素。对肥胖患者进行普通外科手术的保守态度不再合理。
