Esemuede Iyare O, Murray Alice C A, Lee-Kong Steven A, Feingold Daniel L, Kiran Ravi P
New York Presbyterian Columbia University Medical Center, 177 Fort Washington Ave, 7th Floor South Knuckle, New York, NY, 10032, USA.
J Gastrointest Surg. 2014 Dec;18(12):2163-8. doi: 10.1007/s11605-014-2672-4. Epub 2014 Oct 21.
An elevated body mass index (BMI) is associated with increased morbidity and mortality after colorectal surgery. While coexistent comorbid conditions are captured in some determinations of case-severity, BMI itself is not factored into pay for performance (P4P) initiatives. From the National Surgical Quality Improvement Program database 2006-2011, obese (BMI ≥30 kg/m(2)) and nonobese (BMI <30 kg/m(2)) patients with and without comorbidity undergoing colorectal resection were identified. Pre- and intraoperative factors as well as postoperative outcomes were compared. Of 130,415 patients, 31.3 % were obese. 80.4 % of obese and 72.9 % of nonobese patients had comorbid conditions. Among obese patients, overall rates of surgical site infection (SSI), wound dehiscence, and various medical complications were significantly higher for those with comorbidity compared to those without (p < 0.001 for all). Obese patients with comorbidity overall had greater risk of renal failure and urinary tract infection than nonobese patients. Regardless of comorbidity, obese patients more commonly had pulmonary embolism, failure to wean from the ventilator, overall SSI, and wound dehiscence. Comorbid factors associated with obesity influence outcomes; however, obesity itself in their absence is associated with worse outcomes. This supports inclusion of obesity as an independent determinant of case-severity, quality, and reimbursement after colorectal surgery.
较高的体重指数（BMI）与结直肠手术后发病率和死亡率的增加相关。虽然在一些病例严重程度的判定中考虑了并存的合并症，但BMI本身并未纳入绩效薪酬（P4P）计划。从2006 - 2011年国家外科质量改进计划数据库中，识别出接受结直肠切除术的肥胖（BMI≥30 kg/m²）和非肥胖（BMI < 30 kg/m²）且有或无合并症的患者。比较术前和术中因素以及术后结果。在130415例患者中，31.3%为肥胖患者。80.4%的肥胖患者和72.9%的非肥胖患者有合并症。在肥胖患者中，有合并症者的手术部位感染（SSI）、伤口裂开和各种医疗并发症的总体发生率显著高于无合并症者（所有p < 0.001）。有合并症的肥胖患者总体上比非肥胖患者有更高的肾衰竭和尿路感染风险。无论有无合并症，肥胖患者更常发生肺栓塞、脱机失败、总体SSI和伤口裂开。与肥胖相关的合并因素影响结局；然而，在没有这些因素时肥胖本身也与更差结局相关。这支持将肥胖作为结直肠手术后病例严重程度、质量和报销的独立决定因素。
