Rios-Diaz Arturo J, Lin Elissa, Williams Katherine, Jiang Wei, Patel Vihas, Shimizu Naomi, Metcalfe David, Olufajo Olubode A, Cooper Zara, Havens Joaquim, Salim Ali, Askari Reza
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Am J Surg. 2017 Sep;214(3):385-389. doi: 10.1016/j.amjsurg.2016.05.006. Epub 2016 Jul 9.
The "obesity paradox" has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs).
The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality.
There were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups.
Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.
“肥胖悖论”已在慢性疾病中得到证实，但在急性外科手术中尚未得到证实。我们试图确定肥胖是否与严重软组织感染（SSTIs）患者的预后改善相关。
使用2006年至2010年全国住院患者样本确定患有SSTIs的成年患者。患者被分为非肥胖和肥胖（非病态[体重指数30至39.9]和病态[体重指数≥40]）。逻辑回归提供了肥胖类别与住院死亡率之间的风险调整关联。
有2868条SSTI记录，加权后代表14080名患者。肥胖患者比非肥胖患者住院死亡的可能性更小（优势比[OR]=0.42；95%置信区间[CI]，0.25至0.70；P=0.001）。亚分析显示了类似的趋势，非病态肥胖组（OR=0.46；95%CI，0.23至0.91；P=0.025）和病态肥胖组（OR=0.39；95%CI，0.19至0.80；P=0.011）的死亡几率较低。
无论肥胖分类如何，肥胖都与SSTI患者住院死亡率降低独立相关。这表明在这一急性外科人群中存在肥胖悖论。
