Montefiore Medical Center, Bronx, New York.
Montefiore Medical Center, Bronx, New York.
Surg Obes Relat Dis. 2020 Jul;16(7):894-899. doi: 10.1016/j.soard.2020.03.025. Epub 2020 Apr 2.
Bariatric surgery offers patients short- and long-term benefits to their health and quality of life. Currently, we see more patients with superior body mass index (BMI) looking for these benefits. Evidence-based medicine is integral in the evaluation of risks versus benefit; however, data are lacking in this high-risk population.
To assess the morbidity and mortality of patients with BMI ≥70 undergoing bariatric surgery.
University Hospital, Bronx, New York, United States using national database.
Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for years 2005 to 2016, we identified patients who underwent primary laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. Patients with BMI ≥70 were assigned to the BMI >70 (BMI70+) cohort and less obese patients were assigned to the BMI <70 (U70) cohort. Length of stay and 30-day morbidity and mortality were compared.
A total of 163,413 patients underwent non-revisional bariatric surgery. Of those, 2322 had a BMI ≥70. BMI70+ was associated with increased mortality (.4% versus .1%, P = .0001), deep vein thrombosis (.6% versus .3%, P = .007), pulmonary (1.9% versus .5%, P = .0001), renal (.9% versus .2%, P = .0001), and infectious complications (1.1% versus .4%, P = .0001). BMI70+ patients had longer mean length of stay (2.6 versus 2.1 d, P = .0001) and operative time (126.1 versus 114.5 min, P = .0001). There was no statistically significant difference in the number of myocardial infarctions (.1% versus .1%, P = .319), pulmonary embolisms (.3% versus .2%, P = .596), and transfusion requirements (.1% versus .1%, P = .105) between groups.
Evaluation of risk and benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for BMI70+ patients undergoing bariatric surgery was increased over U70 patients but was still relatively low. Our study will allow surgeons to incorporate objective data into their assessment of risk for super-obese patients pursuing bariatric surgery.
减重手术为患者的健康和生活质量带来了短期和长期的益处。目前，我们看到更多身体质量指数（BMI）较高的患者寻求这些益处。循证医学是评估风险与益处的重要组成部分；然而，在这个高风险人群中，数据仍然缺乏。
评估 BMI≥70 的患者接受减重手术后的发病率和死亡率。
美国纽约布朗克斯大学医院，使用国家数据库。
使用美国外科医师学院-国家外科质量改进计划（ACS-NSQIP）数据库，对 2005 年至 2016 年期间接受腹腔镜袖状胃切除术或腹腔镜 Roux-en-Y 胃旁路术的患者进行分析。BMI≥70 的患者被分配到 BMI>70（BMI70+）组，而 BMI 较低的患者被分配到 BMI<70（U70）组。比较住院时间和 30 天发病率和死亡率。
共有 163413 例患者接受了非修正减重手术。其中，2322 例患者 BMI≥70。BMI70+与死亡率增加相关（0.4%比 0.1%，P=0.0001），深静脉血栓形成（0.6%比 0.3%，P=0.007），肺部（1.9%比 0.5%，P=0.0001），肾脏（0.9%比 0.2%，P=0.0001）和感染性并发症（1.1%比 0.4%，P=0.0001）。BMI70+患者的平均住院时间（2.6 天比 2.1 天，P=0.0001）和手术时间（126.1 分钟比 114.5 分钟，P=0.0001）更长。两组间心肌梗死发生率（0.1%比 0.1%，P=0.319）、肺栓塞发生率（0.3%比 0.2%，P=0.596）和输血需求（0.1%比 0.1%，P=0.105）无统计学差异。
对风险和益处的评估是基于个案的，但循证医学对于赋予外科医生和患者做出明智决策的能力至关重要。BMI70+患者接受减重手术后的发病率和死亡率总体上高于 U70 患者，但仍相对较低。我们的研究将使外科医生能够将客观数据纳入对接受减重手术的超肥胖患者的风险评估中。
