Department of Anesthesiology, Division of Regional Anesthesia, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
J Clin Anesth. 2021 Sep;72:110306. doi: 10.1016/j.jclinane.2021.110306. Epub 2021 Apr 24.
It is unclear what the body mass index (BMI) should be when performing surgery involving the airway at an outpatient surgery facility. The objective of this study was to evaluate the association of Class 3 obesity versus a composite cohort of Class 1 and 2 obesity with same-day hospital admission following outpatient tonsillectomy in adults.
Retrospective cohort study.
Multi-institutional.
Patients undergoing outpatient tonsillectomy.
None.
We used the National Surgical Quality Improvement Program (NSQIP) to analyze association of BMI to same-day admission and 30-day readmission following outpatient tonsillectomy from 2017 to 2019. We looked at six BMI cohorts: 1) ≥30 and < 40 kg/m (reference cohort), 2) ≥20 and < 30 kg/m, 3) <20 kg/m, 4) ≥40 and < 50 kg/m, 5) ≥50 and < 60 kg/m, and 6) ≥60 kg/m. We used multivariable Poisson regression with robust standard errors and controlled for various confounders to calculate risk ratios (RR) and 99% confidence intervals (CI).
There were 12,287 patients included in the final analysis, at which 697 (5.7%) and 283 (2.3%) had a same-day admission or 30-day readmission, respectively. On Poisson regression with robust standard errors, the relative risks for BMI ≥40 kg/m and < 50 kg/m, ≥50 kg/m and < 60 kg/m, and ≥ 60 kg/m (BMI ≥30 kg/m and < 40 kg/m was the reference group) were 1.31 (99% CI 1.03-1.65, p = 0.03), 1.99 (99% CI 1.43-2.78, p = 0.002), and 1.80 (99% CI 1.00-3.25, p = 0.07), respectively. Furthermore, Class 3 obesity was not associated with 30-day readmission.
These results contribute data that may help practices - especially freestanding ambulatory surgery centers - decide appropriate BMI cutoffs for surgery involving the airway. Whether this is considered clinically significant enough to rule out eligibility will differ from practice-to-practice and will depend on surgical volume, resources available and financial interests.
在门诊手术设施进行涉及气道的手术时，体质量指数（BMI）应该是多少尚不清楚。本研究的目的是评估 3 类肥胖与 1 类和 2 类肥胖复合队列与成人门诊扁桃体切除术后当天住院之间的关联。
回顾性队列研究。
多机构。
接受门诊扁桃体切除术的患者。
无。
我们使用国家外科质量改进计划（NSQIP）分析 BMI 与门诊扁桃体切除术后当天和 30 天再入院之间的关系，从 2017 年到 2019 年。我们观察了六个 BMI 队列：1）≥30 且<40 kg/m（参考队列），2）≥20 且<30 kg/m，3）<20 kg/m，4）≥40 且<50 kg/m，5）≥50 且<60 kg/m，6）≥60 kg/m。我们使用多变量泊松回归和稳健标准差，并控制了各种混杂因素，以计算风险比（RR）和 99%置信区间（CI）。
最终分析共纳入 12287 例患者，其中 697 例（5.7%）和 283 例（2.3%）当天或 30 天内再入院。在稳健标准误的泊松回归中，BMI≥40 kg/m 和<50 kg/m、≥50 kg/m 和<60 kg/m 以及≥60 kg/m（BMI≥30 kg/m 和<40 kg/m 为参考组）的相对风险分别为 1.31（99%CI 1.03-1.65，p=0.03）、1.99（99%CI 1.43-2.78，p=0.002）和 1.80（99%CI 1.00-3.25，p=0.07）。此外，3 类肥胖与 30 天再入院无关。
这些结果提供了有助于实践的数据，特别是独立的门诊手术中心可以决定涉及气道的手术的适当 BMI 截止值。这是否被认为在临床上有足够的意义而排除资格将因实践而异，并将取决于手术量、可用资源和经济利益。
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