Beresneva Olga, Hall Jason
Boston University/Boston Medical Center, Department of Surgery, 88 East Newton St, C515, Boston, MA 02118.
Surg Open Sci. 2019 Jul 29;1(2):80-85. doi: 10.1016/j.sopen.2019.07.001. eCollection 2019 Oct.
We hypothesized that increasing body mass index is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of body mass index and surgical complications following surgery for diverticular disease.
We used National Surgical Quality Improvement Program database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their body mass index (< 18.5, 18.6-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, 50.0-54.9, > 55). Outcomes of interest were complications of superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, pneumonia, ventilator dependence > 48 hours, acute renal failure, myocardial infarction, return to operating room, and 30-day mortality.
Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher American Society of Anesthesiologists classification and were more likely to have emergency and open cases. Interestingly, increased body mass index was inversely associated with age. Increasing body mass index was associated with worse outcomes including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to operating room. Risk of developing pneumonia didn't have similar correlation with body mass index. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of myocardial infarction were noted. Underweight patients also developed worse outcomes.
Obesity is associated with a number of complications following surgery for diverticulitis. Elevated body mass index adds significant risk to procedures for diverticulitis and should be accounted for in risk stratification models. Patients should be counseled on weight reduction before undergoing elective surgery for diverticular disease.
我们假设体重指数增加是憩室炎手术中手术并发症的一个危险因素。我们评估了体重指数与憩室病手术后手术并发症之间的关系。
我们使用了2005年至2015年的国家外科质量改进计划数据库。纳入了在此期间接受憩室病手术的患者，并根据其体重指数（<18.5、18.6 - 24.9、25.0 - 29.9、30.0 - 34.9、35.0 - 39.9、40.0 - 44.9、45.0 - 49.9、50.0 - 54.9、>55）分为9组。感兴趣的结局包括浅表手术部位感染、深部切口手术部位感染、器官间隙手术部位感染、伤口裂开并发症、肺炎、呼吸机依赖>48小时、急性肾衰竭、心肌梗死、返回手术室和30天死亡率。
病态肥胖患者的糖尿病、高血压和类固醇使用发生率较高。他们的美国麻醉医师协会分级较高，更有可能接受急诊和开放性手术。有趣的是，体重指数增加与年龄呈负相关。体重指数增加与更差的结局相关，包括浅表手术部位感染、深部切口手术部位感染、器官间隙手术部位感染、伤口裂开并发症、呼吸机依赖>48小时、急性肾衰竭和返回手术室。发生肺炎的风险与体重指数没有类似的相关性。超重状态对死亡率有保护作用。未观察到心肌梗死发生率增加的统计学显著差异。体重过轻的患者也出现了更差的结局。
肥胖与憩室炎手术后的多种并发症相关。体重指数升高会给憩室炎手术增加显著风险，应在风险分层模型中予以考虑。对于接受憩室病择期手术的患者，应在术前给予减重建议。
