Walia Hina, Balaban Onur, Jacklen Megan, Tumin Dmitry, Raman Vidya, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
School of Medicine, The Ohio State University, Columbus, OH, USA.
J Anesth. 2017 Aug;31(4):510-516. doi: 10.1007/s00540-017-2326-2. Epub 2017 Feb 27.
Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95-98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery.
In a retrospective review over a 6-month period, obese children, 2-18 years of age undergoing surgery were identified. Multivariate mixed-effects regression was used to compare PACU length of stay (LOS) need for opioid analgesia, and hospital admission between moderately and severely obese patients.
There were 1324 records selected for inclusion. PACU LOS did not significantly differ between moderately obese (50 ± 36 min) and severely obese patients (55 ± 38 min). There were no differences between moderately and severely obese patients in use of opioids in the PACU. Yet, severely obese patients were more likely to require inpatient admission than moderately obese patients.
The duration of PACU stay still averaged less than 1 h in our cohort, suggesting that the majority of these patients can be cared for safely in the outpatient setting. Future studies should focus on identifying the co-morbid conditions that may prolong postoperative PACU stay or result in unplanned hospital admission in moderately and severely obese patients. Our preliminary data suggest that these factors may include a younger age and the complexity or duration of the surgical procedure.
肥胖是成人和儿童手术并发症的一个危险因素。儿童术后结局根据肥胖严重程度（中度：95 - 98岁年龄性别特异性体重指数（BMI）百分位数，重度：≥99百分位数）的差异仍不明确。本研究比较了接受手术的重度肥胖儿童和中度肥胖儿童在麻醉后护理单元（PACU）的停留时间和住院情况。
在一项为期6个月的回顾性研究中，确定了2 - 18岁接受手术的肥胖儿童。采用多变量混合效应回归比较中度和重度肥胖患者在PACU的住院时间（LOS）、阿片类镇痛药物的需求以及住院情况。
共纳入1324份记录。中度肥胖患者（50 ± 36分钟）和重度肥胖患者（55 ± 38分钟）在PACU的停留时间无显著差异。中度和重度肥胖患者在PACU使用阿片类药物方面也无差异。然而，重度肥胖患者比中度肥胖患者更有可能需要住院治疗。
在我们的队列中，PACU停留时间平均仍不到1小时，这表明这些患者中的大多数可以在门诊环境中得到安全护理。未来的研究应侧重于确定可能延长中度和重度肥胖患者术后PACU停留时间或导致意外住院的合并症。我们的初步数据表明，这些因素可能包括年龄较小以及手术的复杂性或持续时间。
