Hajibandeh S, Hajibandeh S, Harries K, Lewis W G, Egan R J
Swansea Bay University Health Board, UK.
University Hospitals of North Midlands NHS Trust, UK.
Ann R Coll Surg Engl. 2025 Apr;107(4):242-252. doi: 10.1308/rcsann.2024.0057. Epub 2024 Aug 14.
The aim of this study was to investigate the effect of body mass index (BMI, kg/m) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes.
A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias.
A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, =0.040) but did not affect complications (OR: 0.69, =0.400) or length of hospital stay (mean difference [MD]: -0.01 days, =0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, <0.00001), and higher risk of wound complications (OR: 3.01, <0.00001) and hospital readmission (OR: 1.46, =0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, <0.0001) and hospital readmission (OR: 5.56, <0.00001), and longer operative time (MD: 4.01 minutes, =0.030).
Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.
本研究旨在探讨体重指数（BMI，kg/m²）对高容量低复杂性（HVLC）普通外科手术结局的影响，并确定在选择患者进入HVLC项目时BMI的临界值。
根据PRISMA（系统评价和Meta分析的首选报告项目）指南，对不同BMI类别患者接受HVLC普通外科手术（腹腔镜胆囊切除术、腹股沟疝修补术和脐疝或脐旁疝修补术）的研究进行系统评价。构建比较Meta分析模型，采用随机效应模型比较结局。使用QUIPS（预后研究质量）工具和GRADE（推荐评估、制定和评价分级）系统评估偏倚。
共审查了26项研究，包括486392名患者。在腹腔镜胆囊切除术中，BMI≥40与更高的转为开放手术的比例相关（比值比[OR]：1.33，P=0.040），但不影响并发症（OR：0.69，P=0.400）或住院时间（平均差[MD]：-0.01天，P=0.900）。在腹股沟疝修补术中，BMI≥35与更长的手术时间相关（MD：18.00分钟，P<0.00001），以及更高的伤口并发症风险（OR：3.01，P<0.00001）和再次入院风险（OR：1.46，P=0.0008）。在脐疝或脐旁疝修补术中，BMI≥30与更高的伤口并发症风险（OR：6.45，P<0.0001）和再次入院风险（OR：5.56，P<0.00001）以及更长的手术时间相关（MD：4.01分钟，P=0.030）。
在HVLC手术中，肥胖与更长的手术时间（长达23分钟）和更高的术后发病率风险（高达4倍）相关。BMI<40（中等GRADE确定性 - 腹腔镜胆囊切除术）和BMI<35（中等GRADE确定性 - 腹股沟疝）似乎代表围手术期安全指标的最佳临界值。
