Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA.
J Intensive Care Med. 2012 Sep-Oct;27(5):306-11. doi: 10.1177/0885066611411410. Epub 2011 Jul 21.
Obesity has long been considered a risk factor for the development of various pathologies, yet evidence supporting increased risk of perioperative mortality in obese individuals developing postoperative complications is limited. Therefore, we sought to characterize the demographics of obese and nonobese individuals developing postoperative respiratory insufficiency (RI)/adult respiratory distress syndrome (ARDS) and to quantify the impact of obesity on in-hospital mortality among this patient population utilizing data collected for the Nationwide Inpatient Sample (NIS).
Nationwide Inpatient Sample data for each year between 1998 and 2007 were accessed. Entries were included if they underwent a surgical procedure and had a diagnosis of RI/ARDS following surgery. Patients fulfilling entry criteria were divided into those with and without obesity. In-hospital mortality was the primary outcome. A logistic regression model was fitted to elucidate if obesity was associated with increased odds for the outcome while controlling for age, gender, admission and procedure type, and comorbidity burden.
We identified 9 149 030 admissions that underwent the included surgical procedures between 1998 and 2007. Of those, 5.48% had a diagnosis of obesity. The incidence of RI/ARDS was 1.82% among obese and 2.01% among nonobese patients. Obese patients whose postoperative course was complicated by RI/ARDS had a significantly lower incidence of the need for mechanical ventilation (50% vs 55%). In-hospital mortality was significantly lower compared to nonobese patients (5.45% vs 18.72%). For those patients with RI/ARDS requiring intubation, the in-hospital mortality rate was 11% for obese and 25% for nonobese patients. In the multivariate regression analysis, obesity was associated with a 69% reduction in the odds of in-hospital mortality in postoperative patients with RI/ARDS.
In our analysis, obesity was associated with a decreased incidence and adjusted odds for in-hospital mortality after surgery. Our results support the emerging concept of the "obesity paradox."
肥胖长期以来一直被认为是多种病理发生的危险因素，但支持肥胖个体发生术后并发症时围手术期死亡率增加的证据有限。因此，我们试图描述肥胖和非肥胖患者术后发生呼吸功能不全（RI）/成人呼吸窘迫综合征（ARDS）的人口统计学特征，并利用全国住院患者样本（NIS）收集的数据量化肥胖对该患者人群住院死亡率的影响。
获取了 1998 年至 2007 年期间每年的全国住院患者样本数据。如果患者接受了手术，并在手术后诊断出 RI/ARDS，则将其纳入研究。符合纳入标准的患者分为肥胖和非肥胖两组。住院死亡率是主要结局。使用逻辑回归模型来阐明肥胖是否与增加的结局发生几率相关，同时控制年龄、性别、入院和手术类型以及合并症负担。
我们确定了 1998 年至 2007 年间进行了纳入手术的 9149030 例住院患者。其中，5.48%的患者诊断为肥胖。肥胖患者的 RI/ARDS 发生率为 1.82%，非肥胖患者的发生率为 2.01%。肥胖患者的 RI/ARDS 术后发生需要机械通气的比例明显较低（50%对 55%）。与非肥胖患者相比，住院死亡率显著降低（5.45%对 18.72%）。对于需要插管的 RI/ARDS 患者，肥胖患者的住院死亡率为 11%，而非肥胖患者的住院死亡率为 25%。在多变量回归分析中，肥胖与术后发生 RI/ARDS 的患者的住院死亡率降低 69%相关。
在我们的分析中，肥胖与手术后的发病率和调整后的住院死亡率降低相关。我们的结果支持“肥胖悖论”这一新兴概念。
