Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
J Am Coll Surg. 2013 Oct;217(4):656-64. doi: 10.1016/j.jamcollsurg.2013.03.031. Epub 2013 Jul 25.
Obesity is a growing epidemic in the United States (US) affecting more than 33% of adults. We aimed to use the World Health Organization (WHO) obesity stratification scheme to assess the overall risk of obese patients undergoing breast reconstruction using the ACS-NSQIP database from 2005 to 2010.
We reviewed the 2005 to 2010 ACS-NSQIP databases identifying encounters for Current Procedural Terminology (CPT) codes including either implant-based reconstruction (immediate, delayed, and tissue expander) or autologous reconstruction (pedicled transverse rectus abdominis myocutaneous [pTRAM], free TRAM, and latissimus dorsi flap with or without implant). Patients were classified and compared based on WHO obesity criteria: nonobese (body mass index [BMI] = 20 to 29.9 kg/m(2)), class I (BMI = 30 to 34.9 kg/m(2)), class II (BMI = 35 to 39.9 kg/m(2)), and class III (BMI > 40 kg/m(2)).
During the study period 15,937 breast reconstructions were performed. The majority of reconstructions were immediate reconstructions (85.0%) and implant-based (79.1%). The incidence of obesity was 27.1%, with 16.3% defined as class I obese, 6.9% defined as class II obese, and 4.0% defined as class III obese. The WHO-classified obese patients tended to have a progressively higher incidence of comorbid conditions, higher American Society of Anesthesiologists (ASA) physical status (p < 0.001), longer operative times (p = 0.0001), and greater lengths of hospital stay (p = 0.0001). Progressively higher BMIs were associated with higher rates of complications, including wound (p < 0.001), medical (p < 0.001), infections (p < 0.001), major surgical (p < 0.001), graft and prosthesis loss (p < 0.001), and return to the operating room (p < 0.001).
This study characterized the effect of progressive obesity on the incidence of surgical and medical complications after breast reconstruction using a large, prospective multicenter dataset. Increasing obesity is associated with increased perioperative morbidity. Data derived from this cohort study can be used to risk-stratify patients, enhance risk counseling, and advocate for institutional reimbursement in obese patients undergoing breast reconstruction.
肥胖是美国日益严重的流行疾病，影响了超过 33%的成年人。我们旨在使用世界卫生组织（WHO）肥胖分层方案，利用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库，评估 2005 年至 2010 年间行乳房重建术肥胖患者的整体风险。
我们回顾了 2005 年至 2010 年的 ACS-NSQIP 数据库，确定了当前程序术语（CPT）代码的就诊情况，包括植入物为基础的重建（即刻、延迟和组织扩张器）或自体重建（带或不带植入物的带蒂横行腹直肌肌皮瓣[pedicled transverse rectus abdominis myocutaneous，pTRAM]、游离 TRAM 和背阔肌皮瓣）。患者根据 WHO 肥胖标准进行分类和比较：非肥胖（体重指数[BMI] = 20 至 29.9 kg/m²）、I 类（BMI = 30 至 34.9 kg/m²）、II 类（BMI = 35 至 39.9 kg/m²）和 III 类（BMI > 40 kg/m²）。
在研究期间，共进行了 15937 例乳房重建术。大多数重建术为即刻重建术（85.0%）和植入物为基础的重建术（79.1%）。肥胖的发生率为 27.1%，其中 16.3%为 I 类肥胖，6.9%为 II 类肥胖，4.0%为 III 类肥胖。与非肥胖患者相比，WHO 肥胖患者更易出现合并症，美国麻醉医师协会（ASA）身体状况评分更高（p < 0.001），手术时间更长（p = 0.0001），住院时间更长（p = 0.0001）。BMI 越高，并发症发生率越高，包括伤口（p < 0.001）、内科（p < 0.001）、感染（p < 0.001）、重大手术（p < 0.001）、移植物和假体丢失（p < 0.001）和返回手术室（p < 0.001）。
本研究利用大型前瞻性多中心数据集，描述了渐进性肥胖对乳房重建术后手术和内科并发症发生率的影响。肥胖程度增加与围手术期发病率增加相关。从本队列研究中获得的数据可用于对患者进行风险分层，增强风险咨询，并倡导为肥胖患者接受乳房重建术提供机构报销。
