肥胖患者的营养状况是术后并发症、住院时间延长和再次住院的风险因素：一项回顾性队列研究。

Bariatric patients' nutritional status as a risk factor for postoperative complications, prolonged length of hospital stay and hospital readmission: A retrospective cohort study.

机构信息

2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.

2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.

出版信息

Int J Surg. 2018 Aug;56:210-214. doi: 10.1016/j.ijsu.2018.06.022. Epub 2018 Jun 19.

DOI:10.1016/j.ijsu.2018.06.022

PMID:29933099

Abstract

BACKGROUND

The prevalence of obesity is growing worldwide. Malnutrition has been identified as a risk factor, leading to higher morbidity rate and prolonged length of hospital. So far there are no high quality data on the impact of malnutrition on length of hospital stay and morbidity regarding bariatric surgery. The aim of the study was to assess association between nutritional status and outcomes bariatric surgeries.

MATERIAL AND METHODS

The study was a prospective observational study.

INCLUSION CRITERIA

informed consent to participate in the study, age 18-65 years, meeting the eligibility criteria for bariatric treatment, qualification for laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y Gastric By-pass (LRYGB).

EXCLUSION CRITERIA

revision surgery, lack of necessary data. The primary endpoint was the evaluation of protein malnutrition risk prevalence. Secondary: influence of malnutrition risk patients' on treatment course and postoperative complications.

RESULTS

533 patients met inclusion criteria and were analyzed. 169 patients (32%) had qualitative risk of malnutrition. The body mass index (BMI) was significantly higher in malnutritioned group, p = 0.001. Albumins in malnutritioned group was 38 g/l (IQR 35-42), whereas in control group it was 41 g/l (IQR 39-43), p = 0.027. Lymphocyte count in malnutrition risk group and control group were 1.24 10'3/μl (IQR 1.1-1.37) and 1.94 10'3/μl (IQR1.7-2.3) respectively, p < 0.001. In linear regression model, a correlation between BMI and total number of lymphocytes was present, p < 0.001. Malnutrition risk did not affect the total morbidity rate. There was a difference in occurrence of postoperative nausea and vomiting, p = 0.033.

CONCLUSIONS

Higher BMI is associated with greater risk of malnutrition. Proper perioperative care may diminish the impact of malnutrition on adverse effects and length of stay (LOS).

摘要

背景

肥胖症在全球范围内的患病率不断上升。营养不良已被确定为一个风险因素，导致发病率更高和住院时间延长。到目前为止，还没有关于营养不良对肥胖症手术住院时间和发病率影响的高质量数据。本研究的目的是评估营养状况与减重手术结果之间的关系。

材料和方法

这是一项前瞻性观察性研究。

纳入标准

同意参加研究，年龄 18-65 岁，符合减重治疗标准，有资格接受腹腔镜袖状胃切除术（LSG）或腹腔镜 Roux-en-Y 胃旁路术（LRYGB）。

排除标准

翻修手术，缺乏必要的数据。主要终点是评估蛋白质营养不良风险的患病率。次要终点：营养不良风险患者对治疗过程和术后并发症的影响。

结果

533 名符合纳入标准的患者进行了分析。169 名患者（32%）有营养不良风险。营养不良组的体重指数（BMI）明显较高，p=0.001。营养不良组的白蛋白为 38g/l（IQR 35-42），而对照组为 41g/l（IQR 39-43），p=0.027。营养不良风险组和对照组的淋巴细胞计数分别为 1.24×10³/μl（IQR 1.1-1.37）和 1.94×10³/μl（IQR 1.7-2.3），p<0.001。在线性回归模型中，BMI 与总淋巴细胞数之间存在相关性，p<0.001。营养不良风险并不影响总发病率。术后恶心和呕吐的发生率存在差异，p=0.033。