Peck Joshua R, Latchana Nicholas, Michaels Anthony, Hanje Adam J, Hinton Alice, Elkhammas Elmahdi A, Black Sylvester M, Mumtaz Khalid
Joshua R Peck, Anthony Michaels, Adam J Hanje, Khalid Mumtaz, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43120, United States.
World J Hepatol. 2017 Apr 28;9(12):595-602. doi: 10.4254/wjh.v9.i12.595.
To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver transplantation.
The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation (OLT) complications, and short term outcomes of OLT performed from 2003 to 2011 ( = 46509). We divided patients into those with [body mass index (BMI) ≥ 40] and without (BMI < 40) morbid obesity. Multivariable logistic regression analysis was performed to characterize differences in in-hospital mortality, length of stay (LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the results.
Of the 46509 patients who underwent OLT during the study period, 818 (1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female (46.8% 33.4%, = 0.002), Caucasian (75.2% 67.8%, = 0.002), in the low national income quartile (32.3% 22.5%, = 0.04), and have ≥ 3 comorbidities (modified Elixhauser index; 83.9% 45.0%, < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage ( = 0.028) and respiratory complications ( = 0.043). Multivariate and propensity matched analysis showed no difference in mortality (OR: 0.70; 95%CI: 0.27-1.84, = 0.47), LOS (β: -4.44; 95%CI: -9.93, 1.05, = 0.11) and charges for transplantation (β: $15693; 95%CI: -51622-83008, = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays (81.7%) as compared to those without morbid obesity (75.4%, = 0.029).
Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.
研究原位肝移植初次住院期间病态肥胖成年人的死亡率、住院时间和总费用。
查询全国住院患者样本，以获取2003年至2011年进行原位肝移植（OLT）患者的人口统计学资料、医疗资源利用情况、OLT术后并发症及短期预后（n = 46509）。我们将患者分为病态肥胖（体重指数[BMI]≥40）和非病态肥胖（BMI<40）两组。在调整显著混杂因素后，进行多变量逻辑回归分析，以描述病态肥胖患者与非病态肥胖患者在住院死亡率、住院时间（LOS）和OLT费用方面的差异。此外，进行倾向匹配以进一步验证结果。
在研究期间接受OLT的46509例患者中，818例（1.8%）为病态肥胖。病态肥胖受者更可能为女性（46.8%对33.4%，P = 0.002）、白种人（75.2%对67.8%，P = 0.002）、处于全国低收入四分位数（32.3%对22.5%，P = 0.04），且有≥3种合并症（改良埃利克斯豪泽指数；83.9%对45.0%，P<0.001）。病态肥胖患者手术相关出血（P = 0.028）和呼吸并发症（P = 0.043）也有所增加。多变量和倾向匹配分析显示，两组在死亡率（OR：0.70；95%CI：0.27 - 1.84，P = 0.47）、住院时间（β： - 4.44；95%CI： - 9.93，1.05，P = 0.11）和移植费用（β：15693美元；95%CI： - 51622 - 83008，P = 0.64）方面无差异。与非病态肥胖患者相比，病态肥胖患者在工作日进行移植的可能性更高（81.7%对75.4%，P = 0.029）。
病态肥胖可能不会影响OLT受者的住院死亡率和医疗资源利用。然而，在仔细评估合并症后可选择病态肥胖患者。
