Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Tech Coloproctol. 2024 Oct 1;28(1):134. doi: 10.1007/s10151-024-03015-0.
Very low-energy diets (VLEDs) prescribed prior to bariatric surgery have been associated with decreased operative time, technical difficulty, and postoperative morbidity. To date, limited data are available regarding the impact of VLEDs prior to colorectal surgery. We designed this study to determine whether preoperative VLEDs benefit patients with obesity undergoing colorectal surgery.
This is a single-center retrospective cohort study. Individuals undergoing elective colorectal surgery with a body mass index (BMI) of greater than 30 kg/m from 2015 to 2022 were included. The exposure of interest was VLEDs for 2-4 weeks immediately prior to surgery. The control group consisted of patients prior to January 2018 who did not receive preoperative VLED. The primary outcome was 30 day postoperative morbidity. Multivariable logistic regression modeling was used to determine associations with 30 day postoperative morbidity.
Overall, 190 patients were included, 89 patients received VLEDs (median age: 66 years; median BMI: 35.9 kg/m; 48.3% female) and 101 patients did not receive VLEDs (median age: 68 years; median BMI: 32.1 kg/m; 44.6% female). One-hundred four (54.7%) patients experienced 30 day postoperative morbidity. Multivariable regression analysis identified three variables associated with postoperative morbidity: VLEDs [odds ratio (OR) 0.22, 95% confidence intervals (CI) 0.08-0.61, P < 0.01], Charlson comorbidity index (OR 1.25, 95% CI 1.03-1.52, P = 0.02), and rectal dissections (OR 2.71, 95% CI 1.30-5.65, P < 0.01).
The use of a preoperative VLED was associated with a significant reduction in postoperative morbidity in patients with obesity prior to colorectal surgery. A high-quality randomized controlled trial is required to confirm these findings.
术前给予极低能量饮食（VLED）与减少手术时间、技术难度和术后发病率有关。迄今为止，关于结直肠手术前 VLED 的影响的数据有限。我们设计了这项研究，以确定肥胖患者接受结直肠手术前 VLED 是否有益。
这是一项单中心回顾性队列研究。纳入 2015 年至 2022 年间 BMI 大于 30kg/m²的接受择期结直肠手术的个体。感兴趣的暴露是术前 2-4 周给予 VLED。对照组由 2018 年 1 月前未接受术前 VLED 的患者组成。主要结局是 30 天术后发病率。多变量逻辑回归模型用于确定与 30 天术后发病率的关联。
总体而言，共纳入 190 例患者，89 例患者接受 VLED（中位年龄：66 岁；中位 BMI：35.9kg/m²；48.3%女性），101 例患者未接受 VLED（中位年龄：68 岁；中位 BMI：32.1kg/m²；44.6%女性）。104 例（54.7%）患者出现 30 天术后发病率。多变量回归分析确定了与术后发病率相关的三个变量：VLED[比值比（OR）0.22，95%置信区间（CI）0.08-0.61，P<0.01]、Charlson 合并症指数（OR 1.25，95%CI 1.03-1.52，P=0.02）和直肠切除术（OR 2.71，95%CI 1.30-5.65，P<0.01）。
肥胖患者在接受结直肠手术前使用术前 VLED 与术后发病率显著降低相关。需要进行高质量的随机对照试验来证实这些发现。
