Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Department of General Surgery, Shanghai Sixth People's hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
J Surg Res. 2021 Sep;265:195-203. doi: 10.1016/j.jss.2021.02.008. Epub 2021 May 2.
Obesity has long been considered a risk factor for postoperative adverse events in surgery. We sought to study the impact of body mass index (BMI) on the clinical outcomes of the high-risk emergency general surgery (EGS) elderly patients.
All EGS ≥65 years old patients in the 2007-2016 ACS-NSQIP database, identified using the variables 'emergency' and 'surgspec,' were included. Patients were classified into five groups: normal weight: BMI <25 kg/m, overweight: BMI ≥25 kg/m and <30 kg/m, Class I: BMI ≥30 kg/m and <35 kg/m, Class II: BMI ≥35 kg/m and <40 kg/m, and Class III: BMI ≥40 kg/m. Patients with BMI<18.5 kg/m were excluded. Multivariable logistic regression models were built to assess the relationship between obesity and 30-day postoperative mortality, overall morbidity, and individual postoperative complications after adjusting for demographics (e.g., age, gender), comorbidities (e.g., diabetes mellitus, heart failure), laboratory tests (e.g., white blood cell count, albumin), and operative complexity (e.g., ASA classification).
A total of 78,704 patients were included, of which 26,011 were overweight (33.1%), 13,897 (17.6%) had Class I obesity, 5904 (7.5%) had Class II obesity, and 4490 (5.7%) had Class III obesity. On multivariable analyses, compared to the nonobese, patients who are overweight or with Class I-III obesity paradoxically had a lower risk of mortality, bleeding requiring transfusion, pneumonia, stroke and myocardial infarction (MI). Additionally, the incidence of MI and stroke decreased in a stepwise fashion as BMI progressed from overweight to severely obese (MI: OR: 0.84 [0.73-0.95], OR: 0.73 [0.62-0.86], OR: 0.66 [0.52-0.83], OR: 0.51 [0.38-0.68]; stroke: OR: 0.80 [0.65-0.99], OR: 0.79 [0.62-1.02], OR: 0.71 [0.50-1.00], OR: 0.43 [0.28-0.68]).
In our study of elderly EGS patients, overweight and obese patients had a lower risk of mortality, bleeding requiring transfusion, pneumonia, reintubation, stroke, and MI. Further studies are needed to confirm and investigate the obesity paradox in this patient population.
肥胖长期以来一直被认为是手术术后不良事件的危险因素。我们旨在研究体重指数（BMI）对高危急诊普通外科（EGS）老年患者临床结局的影响。
使用变量“紧急”和“surgspec”，纳入了 2007-2016 年 ACS-NSQIP 数据库中所有年龄≥65 岁的 EGS 患者。患者被分为五组：正常体重：BMI<25kg/m，超重：BMI≥25kg/m且<30kg/m，I 类：BMI≥30kg/m且<35kg/m，II 类：BMI≥35kg/m且<40kg/m，III 类：BMI≥40kg/m。排除 BMI<18.5kg/m 的患者。使用多变量逻辑回归模型，在调整了人口统计学（例如年龄、性别）、合并症（例如糖尿病、心力衰竭）、实验室检查（例如白细胞计数、白蛋白）和手术复杂性（例如 ASA 分类）后，评估肥胖与 30 天术后死亡率、总体发病率以及个别术后并发症之间的关系。
共纳入 78704 例患者，其中 26011 例超重（33.1%），13897 例（17.6%）为 I 类肥胖，5904 例（7.5%）为 II 类肥胖，4490 例（5.7%）为 III 类肥胖。在多变量分析中，与非肥胖者相比，超重或 I-III 类肥胖患者的死亡率、需要输血的出血、肺炎、中风和心肌梗死（MI）风险反而降低。此外，随着 BMI 从超重进展到严重肥胖，MI 和中风的发生率呈逐步下降趋势（MI：OR：0.84[0.73-0.95]，OR：0.73[0.62-0.86]，OR：0.66[0.52-0.83]，OR：0.51[0.38-0.68]；中风：OR：0.80[0.65-0.99]，OR：0.79[0.62-1.02]，OR：0.71[0.50-1.00]，OR：0.43[0.28-0.68]）。
在对老年 EGS 患者的研究中，超重和肥胖患者的死亡率、需要输血的出血、肺炎、重新插管、中风和 MI 风险较低。需要进一步研究来证实和探讨该患者人群中的肥胖悖论。
