Coaston Troy N, Vadlakonda Amulya, Curry Joanna, Mallick Saad, Le Nguyen K, Branche Corynn, Cho Nam Yong, Benharash Peyman
Department of Surgery, University of California, Los Angeles, CA, USA.
Surg Open Sci. 2024 May 18;20:1-6. doi: 10.1016/j.sopen.2024.05.005. eCollection 2024 Aug.
Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC).
Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017-2020 Nationwide Readmissions Database. Patients were stratified by obesity class; class 1 (Body Mass Index [BMI] = 30.0-34.9), class 2 (BMI = 35.0-39.9), and class 3 (BMI ≥ 40.0). Multivariable regression models were developed to assess factors associated with CTO and its association with perioperative complications and resource utilization.
Of 89,476 patients undergoing LC, 40.6 % had BMI ≥ 40.0. Before adjustment, class 3 obesity was associated with increased rates of CTO compared to class 1-2 (4.6 vs 3.8 %; < 0.001). Following adjustment, class 3 remained associated with an increased likelihood of CTO (Adjusted Odds Ratio [AOR] 1.45, 95 % Confidence Interval [CI] 1.31-1.61; ref.: class 1-2). Patients undergoing CTO had increased risk of blood transfusion (AOR 3.27, 95 % CI 2.54-4.22) and respiratory complications (AOR 1.36, 95 % CI 1.01-1.85). Finally, CTO was associated with incremental increases in hospitalization costs (β + $719, 95 % CI 538-899) and length of stay (LOS; β +2.20 days, 95 % CI 2.05-2.34).
Class 3 obesity is a significant risk factor for CTO. Moreover, CTO is associated with increased hospitalization costs and LOS. As the prevalence of obesity grows, improved understanding of operative risk by approach is required to optimize clinical outcomes. Our findings are relevant to shared decision-making and informed consent.
肥胖是胆囊炎的已知危险因素，且与腹腔镜手术中的技术并发症相关。本研究旨在评估肥胖分级与腹腔镜胆囊切除术（LC）中转开腹（CTO）之间的关联。
在2017 - 2020年全国再入院数据库中识别出接受非择期LC的成年肥胖急性胆囊炎患者。患者按肥胖分级分层：1级（体重指数[BMI]=30.0 - 34.9），2级（BMI = 35.0 - 39.9），3级（BMI≥40.0）。建立多变量回归模型以评估与CTO相关的因素及其与围手术期并发症和资源利用的关联。
在89476例接受LC的患者中，40.6%的患者BMI≥40.0。调整前，与1 - 2级相比，3级肥胖与CTO发生率增加相关（4.6%对3.8%；<0.001）。调整后，3级仍与CTO可能性增加相关（调整优势比[AOR]1.45，95%置信区间[CI]1.31 - 1.61；对照：1 - 2级）。接受CTO的患者输血风险增加（AOR 3.27，95% CI 2.54 - 4.22）和呼吸并发症风险增加（AOR 1.36，95% CI 1.01 - 1.85）。最后，CTO与住院费用增加（β + 719美元，95% CI 538 - 899）和住院时间（LOS；β + 2.20天，95% CI 2.05 - 2.34）的增加相关。
3级肥胖是CTO的重要危险因素。此外，CTO与住院费用增加和LOS增加相关。随着肥胖患病率的上升，需要通过手术方式更好地了解手术风险以优化临床结局。我们的研究结果与共同决策和知情同意相关。
