Mabeza Russyan Mark, Cho Nam Yong, Vadlakonda Amulya, Sakowitz Sara, Ebrahimian Shayan, Moazzez Ashkan, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Depatment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Surg Open Sci. 2023 Jun 17;14:11-16. doi: 10.1016/j.sopen.2023.06.005. eCollection 2023 Aug.
Prior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes.
Adults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI. Restricted cubic splines were utilized to ascertain the BMI threshold for significantly increased morbidity. Multivariable models were developed to evaluate the association of BMI with outcomes of interest.
Of ~89,924 patients, 0.5 % were considered , 12.9 % , 29.5 % , 29.1 % , 16.6 % , 9.7 % , and 1.7 % . After risk adjustment, class I (Adjusted Odds Ratio [AOR] 1.22, 95 % Confidence Interval [95%CI]: 1.06-1.41), class II (AOR 1.42, 95%CI: 1.21-1.66), class III obesity (AOR 1.76, 95%CI: 1.49-2.09) and superobesity (AOR 2.25, 95 % CI: 1.71-2.95) remained associated with increased odds of overall morbidity relative to normal BMI following open, but not laparoscopic, VHR. A BMI of 32 was identified as the threshold for the most significant increase in predicted rate of morbidity. Increasing BMI was linked to a stepwise rise in operative time and postoperative length of stay.
BMI ≥ 32 is associated with greater morbidity following open, but not laparoscopic VHR. The relevance of BMI may be more pronounced in open VHR and must be considered for stratifying risk, improving outcomes, and optimizing care.
Body mass index (BMI) continues to be a relevant factor in morbidity and resource use for elective open ventral hernia repair (VHR). A BMI of 32 serves as the threshold for significant increase in overall complications following open VHR, though this association is not observed in operations performed laparoscopically.
既往研究已将体重指数（BMI）与腹疝修补术（VHR）的术后结局相关联，不过近期关于这一关联特征的数据有限。本研究使用当代全国队列来调查BMI与VHR结局之间的关联。
利用2016 - 2020年美国外科医师学会国家外科质量改进计划数据库，确定年龄≥18岁接受单纯、择期、原发性VHR的成年人。患者按BMI分层。采用受限立方样条来确定发病率显著增加的BMI阈值。建立多变量模型以评估BMI与感兴趣结局之间的关联。
在约89,924例患者中，0.5%被认为是……，12.9%是……，29.5%是……，29.1%是……，16.6%是……，9.7%是……，1.7%是……。风险调整后，I类（调整后比值比[AOR] 1.22，95%置信区间[95%CI]：1.06 - 1.41）、II类（AOR 1.42，95%CI：1.21 - 1.66）、III类肥胖（AOR 1.76，95%CI：1.49 - 2.09）和超级肥胖（AOR 2.25，95%CI：1.71 - 2.95）在开放（而非腹腔镜）VHR后相对于正常BMI仍与总体发病率增加的几率相关。BMI为32被确定为预测发病率最显著增加的阈值。BMI升高与手术时间和术后住院时间的逐步增加相关。
BMI≥32与开放VHR后更高的发病率相关，但与腹腔镜VHR无关。BMI的相关性在开放VHR中可能更显著，在分层风险、改善结局和优化护理时必须予以考虑。
体重指数（BMI）仍然是择期开放腹疝修补术（VHR）发病率和资源利用的一个相关因素。BMI为32是开放VHR后总体并发症显著增加的阈值，不过在腹腔镜手术中未观察到这种关联。
