Tóth L M, Székely H, Rancz A, Zolcsák Á, Sárközi M D, Ábrahám S, Földvári-Nagy L, Erőss B, Hegyi P, Miheller P
Centre for Translational Medicine Semmelweis University Budapest Hungary.
Department of Biophysics and Radiation Biology, Faculty of Medicine Semmelweis University Budapest Hungary.
Ann Gastroenterol Surg. 2024 Aug 23;9(1):153-160. doi: 10.1002/ags3.12855. eCollection 2025 Jan.
The prevalence of ulcerative colitis (UC) is around 200/100 000 people. Colectomy is required in 7.5%-40% of patients and 58.8%-94% of these operations are elective. Approximately one in two adults with UC are overweight or obese.
Our aim was to compare postoperative complications between obese (defined by a body mass index (BMI) over 30 kg/m) and non-obese UC patients who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA).
Our preregistered protocol can be found on PROSPERO (CRD42022377761). We conducted our search in three databases on the 26th of November 2022. PRISMA 2020 guideline and the Cochrane Handbook were applied. We used the GRADEpro program and the QUIPS tool. We applied a random-effects model to pool effect sizes. We included cohort and case-control studies investigating UC patients undergoing colectomy with IPAA and reported information on postoperative complications in obese and non-obese patients. We used mean difference (MD) for continuous variables and calculated odds ratio (OR) with a 95% confidence interval (CI) for dichotomous variables.
Of the 6870 hits of our systematic search, we included three retrospective cohort studies for analyses involving 4929 patients in our research. Neither the incidence of complications at 30 days after surgery [OR = 1.08; CI: 0.65-1.79] nor the incidence of septic complications [OR = 1.11; CI: 0.85-1.46] had any clinical relevance, except for the length of hospital stay [MD = 0.36; CI:0.04-0.69]. When we assessed the risk of bias, we found that most of the aspects examined had a moderate overall risk. Our results have very low certainty of evidence.
Our findings suggest that obesity defined as BMI over 30 kg/m may not associated with an increased risk of higher rates of overall postoperative complications compared to non-obese patients. Obesity with a cut-off value of 30 kg/m does not appear to be a primary reason for prehabilitation.
溃疡性结肠炎（UC）的患病率约为200/10万。7.5%-40%的患者需要进行结肠切除术，其中58.8%-94%的手术为择期手术。大约每两名成年UC患者中就有一人超重或肥胖。
我们的目的是比较肥胖（定义为体重指数（BMI）超过30kg/m²）和非肥胖UC患者在接受全直肠结肠切除术加回肠袋肛管吻合术（IPAA）后的术后并发症。
我们预先注册的方案可在PROSPERO（CRD42022377761）上找到。我们于2022年11月26日在三个数据库中进行了检索。应用了PRISMA 2020指南和Cochrane手册。我们使用了GRADEpro程序和QUIPS工具。我们应用随机效应模型来汇总效应量。我们纳入了队列研究和病例对照研究，这些研究调查了接受IPAA结肠切除术的UC患者，并报告了肥胖和非肥胖患者的术后并发症信息。对于连续变量，我们使用均数差（MD），对于二分变量，我们计算比值比（OR）并给出95%置信区间（CI）。
在我们系统检索的6870条记录中，我们纳入了三项回顾性队列研究进行分析，研究涉及4929例患者。术后30天并发症的发生率[OR = 1.08；CI：0.65-1.79]和感染性并发症的发生率[OR = 1.11；CI：0.85-1.46]均无临床意义，但住院时间除外[MD = 0.36；CI：0.04-0.69]。当我们评估偏倚风险时，我们发现所检查的大多数方面总体风险为中度。我们的结果证据确定性非常低。
我们的研究结果表明，与非肥胖患者相比，定义为BMI超过30kg/m²的肥胖可能与术后总体并发症发生率升高的风险增加无关。以30kg/m²为临界值的肥胖似乎不是术前康复的主要原因。
