Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Mar;164(3):675-682. doi: 10.1177/0194599820955180. Epub 2020 Sep 8.
To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery.
Retrospective cohort study.
Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018.
The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m≤ body mass index <30 kg/m) and obese (≥30 kg/m). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression.
Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; < .001), rate of diabetes (18.2% vs 7.2%, < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, = .02) and have disseminated cancer (<1% vs 3.2%, < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, = .022). There was no statistical difference in medical complications ( = .775), unplanned readmissions ( = .286), unplanned reoperations ( = .053), or 30-day mortality ( > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968).
Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.
评估体重指数对接受内镜鼻窦手术的成年患者术后不良事件的影响。
回顾性队列研究。
美国外科医师学会 NSQIP（国家外科质量改进计划）数据库，时间范围为 2006 年至 2018 年。
对接受内镜鼻窦手术的成年患者的 NSQIP 数据库进行了查询。总样本量（N=1546）按非肥胖（18.5kg/m≤体重指数<30kg/m）和肥胖（≥30kg/m）分层。通过卡方分析和多变量逻辑回归比较了人口统计学、合并症、术中变量和术后不良事件。
肥胖患者占队列的 49.7%（n=768）。肥胖患者的美国麻醉医师协会分级更高（III 级，45.1% vs 29.5%；<.001），糖尿病发生率更高（18.2% vs 7.2%；<.001），需要药物治疗的高血压发生率更高（43.1% vs 23.0%；<.001）。非肥胖患者更可能年龄大于 58 岁（23.4% vs 29.0%；=0.02），患有播散性癌症（<1% vs 3.2%；<.001）。肥胖组的手术并发症发生率较低（3.0% vs 5.4%；=0.027），主要是由于围手术期出血的频率较低（1.8% vs 3.7%；=0.022）。在医疗并发症方面无统计学差异（=0.775）、非计划再入院率（=0.286）、非计划再次手术率（=0.053）和 30 天死亡率（>.999）。多变量调整后，肥胖患者发生任何手术并发症的几率降低（调整后的优势比[OR]，0.567；95%置信区间[CI]，0.329-0.979）、围手术期出血（OR，0.474；95%CI，0.239-0.942）和任何不良术后事件（OR，0.740；95%CI，0.566-0.968）。
肥胖并不会增加内镜鼻窦手术后 30 天不良结局的风险，甚至可能对围手术期出血有保护作用。
