Shin Jin Yong, Roh Si-Gyun, Lee Nae-Ho, Yang Kyung-Moo
Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju-si, Chonbuk, Republic of Korea.
Medicine (Baltimore). 2016 Jun;95(26):e4072. doi: 10.1097/MD.0000000000004072.
Obesity is a risk factor for postoperative morbidity in breast reconstruction. Although existing studies about nonbreast reconstruction are limited, previous research has demonstrated that obesity is not an important factor in poor outcomes in nonbreast reconstruction. Our study evaluates the effects of obesity on postoperative morbidity in nonbreast reconstruction in comparison to breast reconstruction. A systematic literature review and meta-analysis was performed using Medline, EMBASE, and Cochrane databases. Obesity was extracted for predictor variables and partial, total loss of flap, and complication were extracted for outcome variables. Subgroup analyses were performed according to reconstruction site. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the studies, and the Cochrane risk of bias tool was used. Publication bias was evaluated using funnel plots. The search strategy identified 944 publications. After screening, 19 articles were selected for review. Partial flap loss, total flap loss, and complications in breast reconstruction occurred significantly more often in obese patients in comparison to nonobese patients (OR = 2.479, P = 0.021 for partial loss, OR = 3.083, P = 0.002 for total loss, OR = 2.666, P = 0.001 for complications). In contrast, partial flap loss, total flap loss, and complications in nonbreast reconstruction were not significantly different in obese patients in comparison to nonobese patients (OR = 0.786, P = 0.629 for partial loss, OR = 0.960, P = 0.961 for total loss, and OR = 1.009, P = 0.536 for complications). In contrast to the relationship between obesity and poor outcomes in breast reconstruction, our study suggests the obesity is not a predisposing factor for poor outcomes in nonbreast reconstruction. Long-term studies are needed to confirm these findings.
肥胖是乳房重建术后发病的一个风险因素。尽管现有关于非乳房重建的研究有限，但先前的研究表明肥胖并非非乳房重建预后不良的重要因素。我们的研究旨在评估肥胖与乳房重建相比对非乳房重建术后发病的影响。使用Medline、EMBASE和Cochrane数据库进行了系统的文献综述和荟萃分析。提取肥胖作为预测变量，提取皮瓣部分、全部丢失以及并发症作为结果变量。根据重建部位进行亚组分析。使用纽卡斯尔-渥太华量表（NOS）评估研究质量，并使用Cochrane偏倚风险工具。使用漏斗图评估发表偏倚。检索策略共识别出944篇出版物。筛选后，选择了19篇文章进行综述。与非肥胖患者相比，肥胖患者乳房重建中皮瓣部分丢失、全部丢失和并发症的发生率明显更高（部分丢失：OR = 2.479，P = 0.021；全部丢失：OR = 3.083，P = 0.002；并发症：OR = 2.666，P = 0.001）。相比之下，与非肥胖患者相比，肥胖患者非乳房重建中皮瓣部分丢失、全部丢失和并发症并无显著差异（部分丢失：OR = 0.786，P = 0.629；全部丢失：OR = 0.960，P = 0.961；并发症：OR = 1.009，P = 0.536）。与肥胖和乳房重建预后不良的关系不同，我们的研究表明肥胖并非非乳房重建预后不良的诱发因素。需要长期研究来证实这些发现。
