Khan Mohemmed N, Russo Jack, Spivack John, Pool Christopher, Likhterov Ilya, Teng Marita, Genden Eric M, Miles Brett A
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Health Policy and Statistics, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 1;143(6):574-579. doi: 10.1001/jamaoto.2016.4304.
Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity.
To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014.
The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0).
Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92).
Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
已提出较高的体重指数（BMI）是手术患者发病和死亡的风险因素。相反，较高的BMI可能对围手术期发病具有保护作用。
探讨较高的BMI是否是头颈部重建手术中游离组织移植术后围手术期和术后感染并发症的独立危险因素。
设计、设置和参与者：这项队列研究纳入了在三级医疗中心接受需要游离组织移植的重大头颈部手术的患者。收集了2007年1月1日至2014年12月31日期间接受治疗的415例患者的数据。
感兴趣的结局是使用游离皮瓣的头颈部手术后的术后感染和并发症。在统计模型中考虑用于调整的协变量包括饮酒量（定义为每天饮酒超过5杯[例如，360毫升啤酒、150毫升葡萄酒或45毫升80度烈酒]）、2型糖尿病、既往放疗、麻醉时间、甲状腺功能减退、吸烟、美国麻醉医师协会分级、接受的抗生素方案（定义为第一代或第二代头孢菌素加或不加盐酸甲硝唑的标准方案与对青霉素过敏患者的替代抗生素方案）以及主刀医生。针对作为较高BMI（>30.0）函数的感染终点发生率建立了多元逻辑回归模型。
在本研究纳入的415例患者中（277例男性[66.7%]和138例女性[33.2%]；平均[标准差]年龄为61.5[13.9]岁），发现2型糖尿病和使用替代抗生素方案与头颈部游离皮瓣手术后感染并发症增加独立相关，在多元逻辑回归模型中，估计比值比分别为2.78（95%置信区间，1.27 - 6.09）和2.67（95%置信区间，1.14 - 6.25）。然而，未发现高BMI作为术后感染并发症的独立危险因素具有统计学意义（估计比值比为1.19；95%置信区间，0.48 - 2.92）。
较高的BMI似乎在头颈部手术游离组织移植术后并发症中不作为独立危险因素起作用。
