Qin Pei-Pei, Wang Zhi-Qiao, Liu Ling, Xiong Qiu-Ju, Liu Dan, Min Su, Wei Ke
Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Anaesthesia. 2025 Feb 18. doi: 10.1111/anae.16573.
Conflicting results have been reported regarding the influence of BMI on postoperative adverse events. The aim of this study was to investigate the association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgical procedures.
This large-scale retrospective study included 125,082 adults who underwent surgery at a university-affiliated tertiary care hospital between 2019 and 2023. The primary endpoint was the incidence of postoperative pulmonary complications. Multivariable logistic regression analyses, subgroup analyses, sensitivity analyses and restricted cubic splines were used to assess the association between BMI and postoperative pulmonary complications.
A total of 6671 patients (5.3%) developed one or more postoperative pulmonary complications. After adjusting for confounders, compared with those patients with a normal weight (BMI 18.5-24.9 kg.m), patients who were underweight (BMI < 18.5 kg.m) had an increased risk of postoperative pulmonary complications (OR 1.24, 95%CI 1.12-1.39, p < 0.001). Patients who were overweight (BMI 25.0-29.9 kg.m) or living with class 1 obesity (BMI 30.0-34.9 kg.m) had a lower risk of postoperative pulmonary complications (OR 0.88, 95%CI 0.83-0.94, p < 0.001 and OR 0.82, 95%CI 0.70-0.96; p = 0.01, respectively). Patients living with obesity class 2/3 (BMI ≥ 35 kg.m) had a similar risk of postoperative pulmonary complications as patients with a normal weight (OR 1.23, 95%CI 0.91-1.66, p = 0.17). There was a J-shaped association between BMI and incidence of postoperative pulmonary complications with the lowest risk at a BMI of 27.4 kg.m.
Patients who were overweight or living with class 1 obesity undergoing non-cardiac, non-obstetric surgery had paradoxically lower risks of postoperative pulmonary complications compared with those of a normal weight. These findings may contradict traditional assumptions about surgical risk and obesity, highlighting the need to re-evaluate the relationship between BMI and postoperative pulmonary complications.
关于体重指数（BMI）对术后不良事件的影响，已有相互矛盾的报道。本研究的目的是调查BMI与接受非心脏、非产科手术的成年患者术后肺部并发症之间的关联。
这项大规模回顾性研究纳入了2019年至2023年间在一家大学附属三级护理医院接受手术的125,082名成年人。主要终点是术后肺部并发症的发生率。采用多变量逻辑回归分析、亚组分析、敏感性分析和限制性立方样条分析来评估BMI与术后肺部并发症之间的关联。
共有6671名患者（5.3%）发生了一种或多种术后肺部并发症。在调整混杂因素后，与体重正常（BMI 18.5 - 24.9kg·m）的患者相比，体重过轻（BMI < 18.5kg·m）的患者术后发生肺部并发症的风险增加（比值比[OR] 1.24，95%置信区间[CI] 1.12 - 1.39，p < 0.001）。超重（BMI 25.0 - 29.9kg·m）或患有1级肥胖（BMI 30.0 - 34.9kg·m）的患者术后发生肺部并发症的风险较低（OR 0.88，95%CI 0.83 - 0.94，p < 0.001；OR 0.82，95%CI 0.70 - 0.96；p = 0.01）。患有2/3级肥胖（BMI≥35kg·m）的患者术后发生肺部并发症的风险与体重正常的患者相似（OR 1.23，95%CI 0.91 - 1.66，p = 0.17）。BMI与术后肺部并发症发生率之间呈J形关联，BMI为27.4kg·m时风险最低。
与体重正常的患者相比，接受非心脏、非产科手术的超重或患有1级肥胖的患者术后发生肺部并发症的风险反而较低。这些发现可能与关于手术风险和肥胖的传统假设相矛盾，凸显了重新评估BMI与术后肺部并发症之间关系的必要性。
