1Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania 2Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 3Division of Colon and Rectal Surgery, University of Virginia Health System, Charlottesville, Virginia 4Division of Colon and Rectal Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Dis Colon Rectum. 2014 Jun;57(6):687-93. doi: 10.1097/DCR.0000000000000097.
There is a mounting body of evidence that suggests worsened postoperative outcomes at the extremes of BMI, yet few studies investigate this relationship in patients undergoing proctectomy for rectal cancer.
We aimed to examine the relationship between BMI and short-term outcomes after proctectomy for cancer.
This was a retrospective study comparing the outcomes of patients undergoing proctectomy for rectal cancer as they relate to BMI.
The American College of Surgeons-National Surgical Quality Improvement Program database was queried for this study.
Patients included were those who underwent proctectomy for rectal neoplasm between 2005 and 2011.
Study end points included 30-day mortality and overall morbidity, including the receipt of blood transfusion, venous thromboembolic disease, wound dehiscence, renal failure, reintubation, cardiac complications, readmission, reoperation, and infectious complications (surgical site infection, intra-abdominal abscess, pneumonia, and urinary tract infection). Univariate logistic regression was used to analyze differences among patients of varying BMI ranges (kg/m; ≤20, 20-24, 25-29, 30-34, and ≥35). When significant differences were found, multivariable logistic regression, adjusting for preoperative demographic and clinical variables, was performed.
A total of 11,995 patients were analyzed in this study. The incidences of overall morbidity, wound infection, urinary tract infection, venous thromboembolic event, and sepsis were highest in those patients with a BMI of ≥35 kg/m (OR, 1.63, 3.42, 1.47, 1.64, and 1.50). Wound dehiscence was also significantly more common in heavier patients. Patients with a BMI <20 kg/m had significantly increased rates of mortality (OR, 1.72) and sepsis (OR, 1.30).
This study was limited by its retrospective design. Furthermore, it only includes patients from the American College of Surgeons-National Surgical Quality Improvement Program database, limiting its generalizability to nonparticipating hospitals.
Obese and underweight patients undergoing proctectomy for neoplasm are at a higher risk for postoperative complications and death.
越来越多的证据表明，BMI 处于极值的患者术后结局较差，但很少有研究调查这种关系在接受直肠癌直肠切除术的患者中是否存在。
我们旨在研究 BMI 与直肠癌直肠切除术后短期结局之间的关系。
这是一项回顾性研究，比较了与 BMI 相关的接受直肠癌直肠切除术患者的结局。
本研究使用美国外科医师学会-国家外科质量改进计划数据库进行。
纳入的患者为 2005 年至 2011 年间接受直肠肿瘤直肠切除术的患者。
研究终点包括 30 天死亡率和总体发病率，包括输血、静脉血栓栓塞疾病、伤口裂开、肾衰竭、重新插管、心脏并发症、再入院、再次手术和感染并发症（手术部位感染、腹腔脓肿、肺炎和尿路感染）。使用单变量逻辑回归分析不同 BMI 范围（kg/m；≤20、20-24、25-29、30-34 和≥35）患者之间的差异。当发现显著差异时，进行多变量逻辑回归，调整术前人口统计学和临床变量。
本研究共分析了 11995 例患者。总体发病率、伤口感染、尿路感染、静脉血栓栓塞事件和脓毒症的发生率在 BMI≥35kg/m 的患者中最高（OR 分别为 1.63、3.42、1.47、1.64 和 1.50）。较重的患者中，伤口裂开也更为常见。BMI<20kg/m 的患者死亡率（OR 1.72）和脓毒症（OR 1.30）发生率显著升高。
本研究受限于其回顾性设计。此外，它仅包括美国外科医师学会-国家外科质量改进计划数据库中的患者，限制了其在非参与医院的普遍性。
接受直肠肿瘤直肠切除术的肥胖和消瘦患者术后并发症和死亡的风险更高。
