Maloney Sean R, Reinke Caroline E, Nimeri Abdelrahman A, Ayuso Sullivan A, Christmas A Britton, Hetherington Timothy, Kowalkowski Marc, Sing Ronald F, May Addison K, Ross Samuel Wade
Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Am Surg. 2022 May;88(5):852-858. doi: 10.1177/0003134820968524. Epub 2021 Feb 3.
Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates.
A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed.
A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9).
When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.
急诊普通外科（EGS）诊断的手术管理涉及一系列可能具有高发病率和死亡率的手术。关于肥胖对患者预后的影响知之甚少。本研究的目的是探讨体重指数（BMI）>30kg/m²与EGS患者死亡率之间的关联。我们假设肥胖患者的死亡率会增加。
对2013年1月至2015年10月期间从美国创伤外科协会EGS ICD-9编码中获取的区域综合卫生系统EGS登记数据进行分析。根据世界卫生组织的分类将患者分为不同的BMI类别。主要结局是30天死亡率。还检查了与社会保障死亡指数相关的长期死亡率。进行了单变量和多变量分析。
共识别出60604次就诊，其中7183例（11.9%）接受了手术干预。患者特征包括53%为女性，平均年龄58.2±18.7岁，64.2%的BMI>30kg/m²，30.2%患有慢性阻塞性肺疾病，19%患有充血性心力衰竭，31.1%患有糖尿病。最常见的手术是腹腔镜胆囊切除术（36.4%）。总体而言，90天死亡率为10.9%。在多变量分析中，与正常BMI相比，所有肥胖类别都对死亡率具有保护作用。体重过轻的患者住院（OR = 1.9，CI = 1.7 - 2.3）、30天（OR = 1.9，CI = 1.7 - 2.1）、90天（OR = 1.8，CI 1.6 - 2.0）、1年（OR = 1.8，CI = 1.7 - 2.0）和3年死亡率（OR = 1.7，CI = 1.6 - 1.9）的风险增加。
按BMI分层时，体重过轻的EGS患者死亡几率最高。矛盾的是，即使在控制潜在混杂因素后，肥胖似乎对死亡具有保护作用。肥胖人群中非手术治疗率的增加可能会影响这些结果。
