From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas; †Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ‡Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; §Ambulatory Surgery Division, Hospital Corporation of America, Austin, Texas; and ‖Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anesth Analg. 2013 Nov;117(5):1082-91. doi: 10.1213/ANE.0b013e3182a823f4.
The incidence of obesity has increased over the past 2 decades. In recent years, several studies have assessed perioperative outcomes in obese patients undergoing ambulatory surgery. However, this evidence has not been reviewed and evaluated systematically.
We conducted a systematic review of studies published between 1948 and May 2012, assessing perioperative outcome in adult obese patients undergoing ambulatory surgery. All studies were eligible for inclusion if they reported perioperative complications including unplanned hospital admission and readmission.
A literature search revealed 23 studies (13 prospective and 10 retrospective), and 1 systematic review assessing laparoscopic bariatric surgery. A total of 106,119 patients were included in the analysis with 62,476 patients included in the prospective trials and 43,643 patients included in the retrospective trials (not including the systematic review of laparoscopic bariatric surgery). Of these, 39,548 patients underwent bariatric surgery. The super obese (body mass index [BMI] >50 kg/m) appear to be at higher risk of complications. Patients undergoing nonbariatric surgery had a lower degree of obesity (BMI approximately 30 kg/m). Patients undergoing bariatric surgery were morbidly obese (BMI >40 kg/m), which is associated with a higher comorbidity burden. However, the lack of increase in unanticipated admission rate in this patient population may be related to thorough preoperative assessment and avoidance of patients with comorbid conditions.
The literature lacks adequate information to make strong recommendations regarding appropriate selection of the obese patients scheduled for ambulatory surgery. The literature does indicate that the super obese (BMI >50 kg/ m) do present an increased risk for perioperative complications, while patient with lower BMIs do not seem to present any increased risk as long as any comorbidities are minimal or optimized before surgery. This review also identifies knowledge gaps and recommends future research required to guide optimal selection of obese patients scheduled for ambulatory surgery.
在过去的 20 年里，肥胖的发病率一直在上升。近年来，有几项研究评估了接受日间手术的肥胖患者的围手术期结局。然而，这些证据尚未经过系统的回顾和评估。
我们对 1948 年至 2012 年 5 月期间发表的研究进行了系统回顾，评估了接受日间手术的成年肥胖患者的围手术期结局。如果研究报告了包括计划外住院和再入院在内的围手术期并发症，则所有研究均符合纳入标准。
文献检索共发现 23 项研究（13 项前瞻性研究和 10 项回顾性研究），以及 1 项评估腹腔镜减重手术的系统综述。共有 106119 名患者纳入分析，其中 62476 名患者纳入前瞻性试验，43643 名患者纳入回顾性试验（不包括腹腔镜减重手术的系统综述）。其中 39548 名患者接受了减重手术。超级肥胖患者（体重指数[BMI]＞50kg/m）似乎有更高的并发症风险。接受非减重手术的患者肥胖程度较低（BMI 约 30kg/m）。接受减重手术的患者患有病态肥胖症（BMI＞40kg/m），这与更高的合并症负担有关。然而，该患者群体中未预料到的入院率并未增加可能与术前全面评估和避免合并症有关。
文献中缺乏足够的信息来对接受日间手术的肥胖患者进行适当选择提出明确建议。文献表明，超级肥胖患者（BMI＞50kg/m）确实存在围手术期并发症风险增加的情况，而 BMI 较低的患者只要在手术前尽量减少或优化任何合并症，似乎不会增加任何风险。本综述还确定了知识空白，并建议开展未来研究，以指导接受日间手术的肥胖患者的最佳选择。
