Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
J Anesth. 2019 Jun;33(3):372-380. doi: 10.1007/s00540-019-02639-z. Epub 2019 Apr 11.
While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs).
In this retrospective cohort study, we evaluated pediatric patients (aged 2-17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class-using the Centers for Disease Control age- and sex-dependent BMI percentiles-and severe PPCs.
Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07-3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53-1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63-1.94), p = 0.73] were associated with PPCs after adjustment.
Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from "availability bias". Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.
虽然高体重指数（BMI）是成人肺部并发症的公认危险因素，但它作为小儿手术后并发症的危险因素的重要性描述得很差。我们评估了 BMI 与严重儿科围手术期肺部并发症（PPCs）之间的关系。
在这项回顾性队列研究中，我们评估了 2015 年小儿国家手术质量改进计划（NSQIP-P）中接受择期手术的儿科患者（2-17 岁）。严重 PPCs 的定义为术后 3 天内肺炎/重新插管，或术后 7 天内肺炎/重新插管作为索引并发症。使用疾病控制中心年龄和性别依赖性 BMI 百分位数，对患者因素和手术病例组合进行调整的单变量和多变量逻辑回归分析，测试 BMI 类别（肥胖、超重、正常体重、消瘦）与严重 PPCs 之间的关系。
在 40949 名患者中，BMI 类别分布如下：消瘦 2740 例（6.7%），正常体重 23630 例（57.7%），超重 6161 例（15.0%），肥胖 8418 例（20.6%）。在单变量分析中，超重 BMI 类别与 PPCs 无关，但在调整后具有统计学意义[比值比 1.84（95%置信区间 1.07-3.15），p=0.03]，并且在多种调整方法中仍然存在。消瘦[比值比 1.01（95%置信区间 0.53-1.94），p=0.97]和肥胖[比值比 1.10（95%置信区间 0.63-1.94），p=0.73]均与 PPCs 无关。
超重的儿科患者有更高的、以前被低估的严重 PPCs 风险。与之前的研究相反，本研究发现肥胖儿童的风险没有增加，这可能是由于偏差、混杂或从“可用性偏差”转变为实践。本研究的结果，加上先前描述肥胖肺部风险的工作，表明肥胖和超重的儿童可能都需要进行围手术期护理评估，以改善结果。
