Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina.
Calc LLC, Wilton, Connecticut.
J Surg Res. 2022 Oct;278:39-48. doi: 10.1016/j.jss.2022.03.017. Epub 2022 May 16.
The incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese and healthy patients undergoing elective plastic surgery and model how operative time influences a complication risk.
Patients undergoing elective breast and body plastic surgery procedures in the 2009-2019 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Complications were compared between metabolically unhealthy obese (body mass index [BMI] > 30 with diabetes and/or hypertension) versus metabolically healthy obese patients (BMI > 30 without diabetes or hypertension). Logistic regression was used to model the probability of wound complications across operative times stratified by metabolic status.
Of 139,352 patients, 13.4% (n = 18,663) had metabolically unhealthy obesity and 23.8% (n = 33,135) had metabolically healthy obesity. Compared to metabolically healthy patients, metabolically unhealthy patients had higher incidence of wound complications (6.9% versus 5.6%; P < 0.001) and adverse events (12.4% versus 9.6%; P < 0.001), in addition to higher 30-d readmission, returns to the operating room, and length of stay (all P < 0.001). After adjustment, BMI (Odds ratio [OR] 7.86), hypertension (OR 1.15), and diabetes (OR 1.25) were independent risk factors for wound complications (all P < 0.001). Among metabolically unhealthy patients, the operative time was log-linear with a wound complication risk (OR 1.21; P < 0.001).
Diabetes and hypertension are additive risk factors with obesity for wound complications in elective plastic surgery. Among patients with metabolically unhealthy obesity, a risk of wound complications increases logarithmically with operative time. This distinction with regard to metabolic state might explain the unclear impact of obesity on surgical outcomes within existing surgical literature.
全国范围内代谢不健康肥胖的发病率正在上升。在这项研究中，我们比较了接受择期整形手术的代谢不健康肥胖患者和健康患者的伤口和整体并发症，并建立模型来研究手术时间如何影响并发症风险。
在 2009-2019 年国家手术质量改进计划（NSQIP）数据库中确定接受择期乳房和身体整形手术的患者。比较代谢不健康肥胖（BMI>30 伴糖尿病和/或高血压）与代谢健康肥胖患者（BMI>30 无糖尿病或高血压）之间的并发症。使用逻辑回归模型来模拟按代谢状态分层的手术时间范围内的伤口并发症的概率。
在 139352 名患者中，13.4%（n=18663）患有代谢不健康肥胖，23.8%（n=33135）患有代谢健康肥胖。与代谢健康患者相比，代谢不健康患者的伤口并发症发生率（6.9%比 5.6%；P<0.001）和不良事件发生率（12.4%比 9.6%；P<0.001）更高，30 天再入院率、返回手术室率和住院时间更长（均 P<0.001）。调整后，BMI（优势比 [OR] 7.86）、高血压（OR 1.15）和糖尿病（OR 1.25）是伤口并发症的独立危险因素（均 P<0.001）。在代谢不健康的患者中，手术时间与伤口并发症风险呈对数线性关系（OR 1.21；P<0.001）。
糖尿病和高血压是肥胖症患者择期整形手术伤口并发症的附加危险因素。在代谢不健康肥胖的患者中，伤口并发症的风险随手术时间呈对数增加。这种与代谢状态的区别可能解释了现有外科文献中肥胖对手术结果的影响不明确的原因。
