Baltimore, Md. From the Departments of Surgery and Medicine, The Johns Hopkins University School of Medicine, and the Departments of Health Policy and Management and Epidemiology, The Johns Hopkins School of Public Health.
Plast Reconstr Surg. 2011 Nov;128(5):395e-402e. doi: 10.1097/PRS.0b013e3182284c05.
The increasing prevalence of obesity may worsen surgical outcomes and confound standardized metrics of surgical quality. Despite anecdotal evidence, the increased risk of complications in obese patients is not accounted for in these metrics. To better understand the impact of obesity on surgical complications, the authors designed a study to measure complication rates in obese patients presenting for a set of elective breast procedures.
Using claims data from seven Blue Cross and Blue Shield plans, the authors identified a cohort of obese patients and a nonobese control group who underwent elective breast procedures covered by insurance between 2002 and 2006. The authors compared the proportion of patients in each group who experienced a surgical complication. Using multivariate logistic regression, the authors calculated the odds of developing a surgical complication when obesity was present.
There were 2403 patients in the obese group (breast reduction, 80.7 percent; reconstruction, 10.3 percent; mastopexy with augmentation, 1.5 percent; mastopexy alone, 3.5 percent; and augmentation alone, 4.0 percent). The occurrence of complications was compared for each procedure to a nonobese control group of 5597 patients. Overall, 18.3 percent of obese patients had a claim for a complication, compared with only 2.2 percent in the control group (p<0.001). Obesity status increased the odds of experiencing a complication by 11.8-fold after adjusting for other variables.
Obesity is associated with a nearly 12-fold increased odds of a postoperative complication after elective breast procedures. As quality measures are increasingly applied to surgical evaluation and reimbursement, appropriate risk adjustment to account for the effect of obesity on outcomes will be essential.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
肥胖症的患病率不断上升，可能会使手术结果恶化，并使手术质量的标准化衡量标准复杂化。尽管有传闻证据，但这些衡量标准并未考虑肥胖患者并发症风险增加的问题。为了更好地了解肥胖对手术并发症的影响，作者设计了一项研究，以衡量接受一组择期乳房手术的肥胖患者的并发症发生率。
作者使用来自七个蓝十字蓝盾计划的数据，确定了一组肥胖患者和非肥胖对照组，这些患者在 2002 年至 2006 年间接受了保险覆盖的择期乳房手术。作者比较了每组中经历手术并发症的患者比例。使用多变量逻辑回归，作者计算了肥胖存在时发生手术并发症的几率。
肥胖组有 2403 名患者（乳房缩小术占 80.7%；重建术占 10.3%；乳房提升加隆胸术占 1.5%；单纯乳房提升术占 3.5%；单纯隆胸术占 4.0%）。将每种手术的并发症发生率与 5597 名非肥胖对照组进行比较。总体而言，18.3%的肥胖患者有并发症索赔，而对照组只有 2.2%（p<0.001）。在调整其他变量后，肥胖状态使发生并发症的几率增加了 11.8 倍。
在接受择期乳房手术后，肥胖与术后并发症的几率增加近 12 倍相关。随着质量衡量标准越来越多地应用于手术评估和报销，对肥胖对结果的影响进行适当的风险调整将至关重要。
临床问题/证据水平：风险，II 级。
