Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229-3039, USA.
Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229-3039, USA.
J Pediatr Urol. 2019 Oct;15(5):521.e1-521.e7. doi: 10.1016/j.jpurol.2019.06.009. Epub 2019 Jun 20.
Obesity has been thought to increase the risk of complications and need for additional resources with surgery, but only a limited amount of evidence is available in the pediatric population.
The objectives were to describe the weight status of pediatric and adolescent patients undergoing a continent urinary tract reconstruction and to determine the association between obesity and 30-day postoperative morbidity.
A retrospective cohort study was performed for pediatric and adolescent patients aged up to 20 years who underwent a continent urinary tract reconstruction between January 2010 and November 2016. Weight status was stratified by the body mass index (BMI) for age z-scores as follows: underweight (<5th percentile), normal (5th to <85th percentiles), overweight (85th to <95th percentiles), and obese (≥95th percentile). Primary outcomes included the duration of intensive care and hospitalization as well as re-admissions and complications within 30 days.
A total of 182 continent reconstructions were identified during the study period. Demographic and peri-operative data are provided in the Table. Weight status was not associated with any primary outcomes on univariate or multivariate analysis. There was also no association in an analysis between the non-overweight or non-obese group (BMI for age z-score <85th) and overweight or obese group (BMI for age z-score ≥85th percentiles); a subgroup analysis between patients with and without myelomeningocele; or a subgroup analysis for wound, infectious, or high-grade (Clavien-Dindo grades III or higher) complications.
Obesity has been consistently associated with an increased risk of surgical site infections and wound complications after a wide variety of surgeries in adults. The results from the present study conflict with those of the few available studies in the pediatric population. The high-risk nature of the present cohort may have mitigated any effect of obesity on 30-day postoperative morbidity. The limitations of the present study include its retrospective design at a single center and the potential misclassification of weight status with the BMI.
Almost 30% of pediatric and adolescent patients undergoing a continent urinary tract reconstruction were overweight or obese. Obesity as determined by the BMI was not associated with 30-day postoperative morbidity.
肥胖被认为会增加手术并发症的风险和对额外资源的需求，但在儿科人群中，只有有限的证据支持这一观点。
本研究旨在描述接受 continent 尿路重建术的儿科和青少年患者的体重状况，并确定肥胖与 30 天术后发病率之间的关系。
本研究回顾性分析了 2010 年 1 月至 2016 年 11 月期间接受 continent 尿路重建术的年龄在 20 岁以下的儿科和青少年患者，根据体重指数（BMI）与年龄的 z 分数将体重状况分层如下：体重不足（<第 5 百分位）、正常（第 5 至<第 85 百分位）、超重（第 85 至<第 95 百分位）和肥胖（≥第 95 百分位）。主要结局包括重症监护和住院时间以及 30 天内再入院和并发症。
在研究期间共确定了 182 例 continent 重建术。表中提供了人口统计学和围手术期数据。单因素和多因素分析均未发现体重状况与任何主要结局相关。在非超重或非肥胖组（BMI 与年龄的 z 分数<第 85 百分位）与超重或肥胖组（BMI 与年龄的 z 分数≥第 85 百分位）之间的分析中，在有无脊髓脊膜膨出的亚组分析中，或在伤口、感染或高级别（Clavien-Dindo 分级 III 或更高）并发症的亚组分析中，均未发现两者之间存在关联。
肥胖与成年人接受各种手术后手术部位感染和伤口并发症的风险增加一致相关。本研究结果与儿科人群中为数不多的现有研究结果相冲突。本研究队列的高风险性质可能减轻了肥胖对 30 天术后发病率的任何影响。本研究的局限性包括其单中心回顾性设计和 BMI 可能导致的体重状况的潜在分类错误。
接受 continent 尿路重建术的儿科和青少年患者中，近 30%的患者超重或肥胖。根据 BMI 确定的肥胖与 30 天术后发病率无关。
