Train A T, Cairo S B, Meyers H A, Harmon C M, Rothstein D H
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
Department of Surgery, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
Pediatr Surg Int. 2017 Nov;33(11):1167-1175. doi: 10.1007/s00383-017-4131-2. Epub 2017 Sep 5.
To examine the effects of obesity on specialty-specific surgical outcomes in children.
Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis.
Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures.
Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.
探讨肥胖对儿童特定专科手术结局的影响。
采用2012 - 2014年国家外科质量改进计划儿科版进行回顾性队列研究。患者包括年龄在2至17岁之间、接受六个专科之一手术的儿童。肥胖是主要的研究变量。关注的结局为术后并发症和手术时间。采用逐步多因素回归分析计算术后并发症发生的比值比。
肥胖与伤口并发症风险显著增加相关（比值比1.24，95%可信区间1.13 - 1.36），但非伤口并发症风险降低（比值比0.68，95%可信区间0.63 - 0.73）以及发病率降低（比值比0.79，95%可信区间0.75 - 0.84）。肥胖并非预测接受耳鼻喉科或整形手术患者术后并发症的显著因素。大多数类型的儿科手术中，肥胖患者的麻醉时间和手术时间显著更长。
肥胖在某些儿科手术专科中会增加伤口并发症风险，且与总体非伤口并发症和发病率降低相关。这些发现表明，肥胖与术后并发症之间的关系较为复杂，可能比之前认为的更依赖于潜在的手术或专科相关因素。
