Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
Am J Surg. 2020 Oct;220(4):1004-1009. doi: 10.1016/j.amjsurg.2020.03.028. Epub 2020 Mar 25.
Prior efforts evaluating obesity as a risk factor for postoperative complications following proctectomy have been limited by sample size and uniform outcome classification.
The ACS NSQIP was queried for patients with non-metastatic rectal adenocarcinoma who underwent elective proctectomy. After stratification by BMI classification, multivariable modeling was used to identify the effect of BMI class on adjusted risk of 30-day outcomes controlling for patient, procedure, and tumor factors.
Of 2241 patients identified, 33.4% had a normal BMI, 33.5% were overweight, 21.1% were obese, and 12.0% were morbidly obese. Increased risk of superficial surgical site infection (SSI) was observed in obese (OR 2.42, 95%CI:[1.36-4.29]) and morbidly obese (OR 3.29, 95%CI:[1.77-6.11]) patients when compared to normal BMI. Morbid obesity was associated with increased risk of any complication (OR 1.44, 95%CI:[1.05-1.96]). BMI class was not associated with risk adjusted odds of anastomotic leak.
Morbid obesity is independently associated with an increased composite odds risk of short-term morbidity following elective proctectomy for cancer primarily due to increased risk of superficial SSI.
先前评估肥胖作为直肠切除术术后并发症风险因素的研究受到样本量和统一结局分类的限制。
对接受择期直肠切除术的非转移性直肠腺癌患者，使用 ACS NSQIP 进行查询。在按 BMI 分类分层后，使用多变量模型确定 BMI 类别对调整后的 30 天结局风险的影响，同时控制患者、手术和肿瘤因素。
在 2241 名患者中，33.4%的患者 BMI 正常，33.5%超重，21.1%肥胖，12.0%为病态肥胖。与 BMI 正常患者相比，肥胖（OR 2.42，95%CI：[1.36-4.29]）和病态肥胖（OR 3.29，95%CI：[1.77-6.11]）患者发生浅表手术部位感染（SSI）的风险增加。病态肥胖与任何并发症的风险增加相关（OR 1.44，95%CI：[1.05-1.96]）。BMI 类别与吻合口漏的风险调整比值无相关性。
病态肥胖与癌症患者择期直肠切除术后短期发病率的复合风险增加独立相关，主要是由于浅表 SSI 的风险增加。
