Srivastava Ananya, Nolan Brodie, Jung James J
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, CAN.
Department of Emergency Medicine, St. Michael's Hospital, Toronto, CAN.
Cureus. 2024 Oct 16;16(10):e71633. doi: 10.7759/cureus.71633. eCollection 2024 Oct.
Background Half of Americans will have obesity, and a quarter will have severe obesity by the year 2030. Postoperative acute renal failure (ARF) is associated with increased morbidity and mortality. Given the increase in the number of patients with obesity undergoing elective surgery, we investigated the relationship between obesity and postoperative ARF after elective general surgery procedures. Methods We performed a retrospective cohort study of patients in the 2015-2019 National Surgical Quality Improvement Program database who underwent elective general surgery procedures. The primary outcome was the presence of postoperative ARF. The patient body mass index (BMI) was categorized as normal (BMI 18.5-24.9), overweight (BMI 25-29.9), obesity class 1 and 2 (BMI 30-39.9), severe obesity (BMI 40-49.9), and extreme obesity (BMI³50). Descriptive statistics and unadjusted comparisons were performed for patients who developed postoperative ARF and those who did not. Multivariable regression analyses were used to model BMI categories and postoperative ARF, adjusting for patient- and surgical-level covariates. Results Among 424,527 patients included in the study, 3638 patients (0.8%) developed ARF. Patients who developed ARF were older, had a higher BMI, and had more serious comorbidities. After risk adjustment, there was a stepwise rise in odds of developing postoperative ARF with increasing BMI categories compared to normal BMI: (overweight: OR 1.11 (95% CI 1.0-1.23), obesity class 1 and 2: OR 1.32 (95% CI 1.2-1.46), severe obesity: OR 1.45 (95% CI 1.27-1.66), and extreme obesity: OR 1.78 (95% CI 1.47-2.15)). Conclusion Obesity is independently associated with ARF after elective general surgery procedures.
到2030年，将有一半的美国人患有肥胖症，四分之一的人将患有严重肥胖症。术后急性肾衰竭（ARF）与发病率和死亡率的增加相关。鉴于接受择期手术的肥胖患者数量增加，我们研究了肥胖与择期普通外科手术后ARF之间的关系。方法：我们对2015 - 2019年国家外科质量改进计划数据库中接受择期普通外科手术的患者进行了一项回顾性队列研究。主要结局是术后ARF的发生情况。患者的体重指数（BMI）分为正常（BMI 18.5 - 24.9）、超重（BMI 25 - 29.9）、1级和2级肥胖（BMI 30 - 39.9）、严重肥胖（BMI 40 - 49.9）和极度肥胖（BMI³50）。对发生术后ARF的患者和未发生的患者进行描述性统计和未调整比较。使用多变量回归分析对BMI类别和术后ARF进行建模，并对患者和手术层面的协变量进行调整。结果：在纳入研究的424,527名患者中，3638名患者（0.8%）发生了ARF。发生ARF的患者年龄更大，BMI更高，合并症更严重。经过风险调整后，与正常BMI相比，随着BMI类别增加，发生术后ARF的几率呈逐步上升趋势：（超重：OR 1.11（95% CI 1.0 - 1.23），1级和2级肥胖：OR 1.32（95% CI 1.2 - 1.46），严重肥胖：OR 1.45（95% CI 1.27 - 1.66），极度肥胖：OR 1.78（95% CI 1.47 - 2.15））。结论：肥胖与择期普通外科手术后的ARF独立相关。
