Rabin Medical Center, Institute of Endocrinology, Beilinson Hospital, , 49100, Petach Tikva, Israel.
Rabin Medical Center, Statistical Consulting Unit, Beilinson Hospital, Petach Tikva, Israel.
World J Surg. 2021 May;45(5):1390-1399. doi: 10.1007/s00268-021-05961-4. Epub 2021 Jan 22.
While obesity is commonly associated with increased morbidity and mortality, in patients with chronic diseases, it has have been associated with a better prognosis, a phenomenon known as the 'obesity paradox'.
We investigated the relationship between mortality, length of hospital stay (LOHS), and body mass index (BMI) in patients hospitalized to general surgical wards.
We extracted data of patients admitted to the hospital between January 2011 and December 2017. BMI was classified according to the following categories: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9), obesity (30-34.9) and severe obesity (≥ 35). Main outcomes were mortality at 30-day mortality and at the end-of-follow-up mortality), as well as LOHS.
A total of 27,639 patients (mean age 55 ± 20 years; 48% males; 19% had diabetes) were included in the study. Median LOHS was longer in patients with diabetes vs. those without diabetes (4.0 vs 3.0 days, respectively), with longest LOHS among underweight patients. A 30-day mortality was 2% of those without (371/22,297) and 3% of those with diabetes (173/5,342). In patients with diabetes, 30-day mortality risk showed a step-wise decrease with increased BMI: 10% for underweight, 6% for normal weight, 3% for overweight, 2% for obese and only 1% for severely obese patients. In patients without diabetes, 30-day mortality was found to be 6% for underweight, 3% for normal weight and 1% across the overweight and obese categories. Mortality rate at the end-of-follow-up was 9% of patients without diabetes and 18% of those with diabetes (adjusted OR = 1.3, 95% CI, 1.2-1.5). In patients with diabetes, mortality risk showed an inverse association with respect to BMI: 52% for underweight, 29% for normal weight, 17% for overweight, 14% for obesity and 7% for severely obese patients, with similar trend in patients without diabetes.
The results support the 'obesity paradox' in the general surgical patients as those with and without diabetes admitted to surgical wards, BMI had an inverse association with short- and long-term mortality.
虽然肥胖通常与发病率和死亡率的增加有关，但在患有慢性疾病的患者中，肥胖与更好的预后有关，这种现象被称为“肥胖悖论”。
我们研究了普外科住院患者的死亡率、住院时间（LOHS）和体重指数（BMI）之间的关系。
我们提取了 2011 年 1 月至 2017 年 12 月期间住院患者的数据。BMI 根据以下类别进行分类：体重不足（<18.5）、正常体重（18.5-24.9）、超重（25-29.9）、肥胖（30-34.9）和重度肥胖（≥35）。主要结局是 30 天死亡率和随访结束时的死亡率，以及 LOHS。
共有 27639 名患者（平均年龄 55±20 岁；48%为男性；19%患有糖尿病）纳入研究。与无糖尿病患者相比，糖尿病患者的 LOHS 中位数较长（分别为 4.0 天和 3.0 天），体重不足患者的 LOHS 最长。无糖尿病患者的 30 天死亡率为 2%（371/22297），糖尿病患者为 3%（173/5342）。在患有糖尿病的患者中，30 天死亡率随着 BMI 的增加呈阶梯式下降：体重不足的患者为 10%，正常体重的患者为 6%，超重的患者为 3%，肥胖的患者为 2%，而重度肥胖的患者仅为 1%。在无糖尿病的患者中，30 天死亡率为体重不足的患者为 6%，正常体重的患者为 3%，超重和肥胖的患者为 1%。无糖尿病患者的随访结束时死亡率为 9%，糖尿病患者为 18%（调整后的 OR=1.3，95%CI，1.2-1.5）。在患有糖尿病的患者中，死亡率与 BMI 呈负相关：体重不足的患者为 52%，正常体重的患者为 29%，超重的患者为 17%，肥胖的患者为 14%，重度肥胖的患者为 7%，无糖尿病的患者也呈现出类似的趋势。
这些结果支持了普外科患者中的“肥胖悖论”，即患有和不患有糖尿病的患者被收入外科病房后，BMI 与短期和长期死亡率呈负相关。
