Burneikis Dominykas, Morris-Stiff Gareth, Chalikonda Sricharan
Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk A100, Cleveland, OH, USA.
World J Surg. 2018 Oct;42(10):3125-3133. doi: 10.1007/s00268-018-4599-5.
Obesity presents a unique challenge in caring for surgical patients and has been shown to adversely affect outcomes for several operative procedures. However, quantitative data on surgical resource utilization attributable to obesity are scarce. The aim of this study was to quantify day-of-surgery resource utilization by degree of obesity.
Patients undergoing one of 14 common surgical procedures at our multicenter institution between 2008 and 2017 were identified from our operating room management databank. Multiple-variable regression analysis (MVRA) was performed to quantify the independent effect of body mass index (BMI) category on day-of-surgery resource utilization variables including procedure time, non-operative OR time, PACU time, number of unique staff and number of supplies used. Trends in mean BMI were examined for each procedure studied.
MVRA of the 189,264 cases in the database revealed consistently significant (p < 0.05) stepwise increase in procedure time by BMI category for all procedures studied. Non-operative OR time was also significantly prolonged, though to a lesser degree. There was no significant impact on number of unique staff, supplies utilized or PACU time by BMI category. Procedures most impacted by BMI category in terms of resource utilization were ventral hernia repair, laminectomy and hysterectomy.
Our study quantified day-of-surgery resource utilization for 14 major surgical procedures by BMI category. The need for additional resources to accommodate patients in higher BMI groups was consistent across all procedures studied and was primarily reflected by lengthened operative times.
肥胖给外科手术患者的护理带来了独特挑战，并且已被证明会对多种手术的结果产生不利影响。然而，关于肥胖所致手术资源利用的定量数据却很匮乏。本研究的目的是按肥胖程度对手术当天的资源利用情况进行量化。
从我们的手术室管理数据库中识别出2008年至2017年期间在我们多中心机构接受14种常见外科手术之一的患者。进行多变量回归分析（MVRA）以量化体重指数（BMI）类别对手术当天资源利用变量的独立影响，这些变量包括手术时间、非手术手术室时间、麻醉后恢复室（PACU）时间、独特工作人员数量和所用耗材数量。对所研究的每种手术的平均BMI趋势进行了检查。
数据库中189,264例病例的MVRA显示，在所研究的所有手术中，按BMI类别划分的手术时间均持续显著（p < 0.05）逐步增加。非手术手术室时间也显著延长，不过延长程度较小。BMI类别对独特工作人员数量、所用耗材数量或PACU时间没有显著影响。在资源利用方面受BMI类别影响最大的手术是腹疝修补术、椎板切除术和子宫切除术。
我们的研究按BMI类别对14种主要外科手术的手术当天资源利用情况进行了量化。在所有研究的手术中，为BMI较高组的患者提供额外资源的需求是一致的，并且主要体现在手术时间延长上。
