Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Dis Colon Rectum. 2018 Aug;61(8):938-945. doi: 10.1097/DCR.0000000000001085.
Obese patients undergoing colorectal surgery are at increased risk for adverse outcomes. It remains unclear whether these risks can be further defined with more discriminatory stratifications of obesity.
The purpose of this study was to understand the association between BMI and 30-day postoperative outcomes, including surgical site infection, among patients undergoing colorectal surgery.
This was a retrospective cohort study.
The 2011-2013 American College of Surgeons National Surgical Quality Improvement Program database was used.
Patients included those undergoing elective colorectal surgery in 2011-2013 who were assessed by the American College of Surgeons National Surgical Quality Improvement Program.
BMI was categorized into World Health Organization categories. Primary outcome was 30-day postoperative surgical site infection. Secondary outcomes included all American College of Surgeons National Surgical Quality Improvement Program-assessed 30-day postoperative complications.
Our cohort included 74,891 patients with 4.4% underweight (BMI <18.5), 29.0% normal weight (BMI 18.5-24.9), 33.0% overweight (BMI 25.0-29.9), 19.8% obesity class I (BMI 30.0-34.9), 8.4% obesity class II (BMI 35.0-39.9), and 5.5% obesity class III (BMI ≥40.0). Compared with normal-weight patients, obese patients experienced incremental odds of surgical site infection from class I to class III (I: OR = 1.5 (95% CI, 1.4-1.6); II: OR = 1.9 (95% CI, 1.7-2.0); III: OR = 2.1 (95% CI, 1.9-2.3)). Obesity class III patients were most likely to experience wound disruption, sepsis, respiratory or renal complication, and urinary tract infection. Mortality was highest among underweight patients (OR = 1.3 (95% CI, 1.0-1.8)) and lowest among overweight (OR = 0.8 (95% CI, 0.6-0.9)) and obesity class I patients (OR = 0.8 (95% CI, 0.6-1.0)).
Retrospective analysis of American College of Surgeons National Surgical Quality Improvement Program hospitals may not represent patients outside of the American College of Surgeons National Surgical Quality Improvement Program and cannot assign causation or account for interventions to improve surgical outcomes.
Patients with increasing BMI showed an incremental and independent risk for adverse 30-day postoperative outcomes, especially surgical site infections. Strategies to address obesity preoperatively should be considered to improve surgical outcomes among this population. See Video Abstract at http://links.lww.com/DCR/A607.
接受结直肠手术的肥胖患者发生不良结局的风险增加。目前尚不清楚这些风险是否可以通过更具鉴别力的肥胖分层来进一步确定。
本研究旨在了解 BMI 与结直肠手术后 30 天内术后结局（包括手术部位感染）之间的关系。
这是一项回顾性队列研究。
使用 2011-2013 年美国外科医师学会国家外科质量改进计划数据库。
纳入 2011-2013 年接受择期结直肠手术且经美国外科医师学会国家外科质量改进计划评估的患者。
BMI 分为世界卫生组织类别。主要结局为 30 天内术后手术部位感染。次要结局包括所有美国外科医师学会国家外科质量改进计划评估的 30 天内术后并发症。
本队列包括 74891 例患者，其中 4.4%为体重不足（BMI＜18.5），29.0%为正常体重（BMI 18.5-24.9），33.0%为超重（BMI 25.0-29.9），19.8%为肥胖 I 级（BMI 30.0-34.9），8.4%为肥胖 II 级（BMI 35.0-39.9），5.5%为肥胖 III 级（BMI≥40.0）。与正常体重患者相比，肥胖患者从肥胖 I 级到肥胖 III 级的手术部位感染几率呈递增趋势（I 级：OR=1.5（95%CI，1.4-1.6）；II 级：OR=1.9（95%CI，1.7-2.0）；III 级：OR=2.1（95%CI，1.9-2.3））。肥胖 III 级患者最易发生伤口破裂、脓毒症、呼吸或肾脏并发症和尿路感染。体重不足患者的死亡率最高（OR=1.3（95%CI，1.0-1.8）），超重患者（OR=0.8（95%CI，0.6-0.9））和肥胖 I 级患者（OR=0.8（95%CI，0.6-1.0））最低。
美国外科医师学会国家外科质量改进计划医院的回顾性分析可能无法代表美国外科医师学会国家外科质量改进计划之外的患者，也无法确定因果关系或说明干预措施以改善手术结果。
BMI 增加的患者发生不良 30 天术后结局（尤其是手术部位感染）的风险呈递增且独立趋势。应考虑术前针对肥胖采取策略，以改善该人群的手术结局。详见视频摘要，网址：http://links.lww.com/DCR/A607。
