肥胖及其对胆囊切除术后发病率和死亡率的影响：一项倾向性匹配的美国国立外科质量改进计划分析
Obesity and its implications for morbidity and mortality after cholecystectomy: A matched NSQIP analysis.
作者信息
Augustin Toms, Moslim Maitham A, Brethauer Stacy, Aminian Ali, Kroh Matthew, Schneider Eric, Walsh R Matthew
机构信息
Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, 75 Francis St, Boston, MA, USA.
出版信息
Am J Surg. 2017 Mar;213(3):539-543. doi: 10.1016/j.amjsurg.2016.11.037. Epub 2017 Jan 26.
BACKGROUND
The risks from super obesity (SO) following cholecystectomy have not been studied.
METHODS
NSQIP analysis of patients undergoing cholecystectomy from 2005 to 2011. Non-obese (NO) patients (BMI 18.5-30) were matched 1:1 by age, sex, race and comorbidities to morbidly obese (MO) (BMI 35-50), and separately to SO (BMI≥50) individuals. Clavien 4 complications and 30-day mortality were compared.
RESULTS
13780 MO and 1410 SO patients were matched to NO patients. Obese patients were more likely to present with chronic (CC) rather than acute cholecystitis (AC). Compared to NO patients, Clavien 4 complications were significantly increased among SO patients overall especially with AC where rate of open surgery was significantly higher.
CONCLUSION
SO patients have an increased risk of serious morbidity after cholecystectomy especially with AC where rate of open surgery remains high. Aggressive recommendation for cholecystectomy to reduce presentation with AC and increase likelihood for laparoscopic surgery may be beneficial in SO patients.
背景
胆囊切除术后超级肥胖（SO）的风险尚未得到研究。
方法
对2005年至2011年接受胆囊切除术的患者进行美国国立外科质量改进计划（NSQIP）分析。非肥胖（NO）患者（BMI 18.5 - 30）按年龄、性别、种族和合并症与病态肥胖（MO）（BMI 35 - 50）患者1:1匹配，并分别与超级肥胖（SO）（BMI≥50）个体匹配。比较Clavien 4级并发症和30天死亡率。
结果
13780名MO患者和1410名SO患者与NO患者匹配。肥胖患者更易出现慢性胆囊炎（CC）而非急性胆囊炎（AC）。与NO患者相比，SO患者总体上Clavien 4级并发症显著增加，尤其是AC患者，其开放手术率显著更高。
结论
SO患者胆囊切除术后严重发病风险增加，尤其是AC患者，其开放手术率仍然很高。积极推荐胆囊切除术以减少AC的发生并增加腹腔镜手术的可能性可能对SO患者有益。
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