Menzie Jack, Coates Thomas, Liew Amos, Fernando Vanisha, Cheong Anderson, Xiao Lulu, King Nicholas, Li Yigeng, Ackermann Travis, Sritharan Mithra, Croagh Daniel, Ooi Geraldine
Department of General Surgery, Monash Health, Clayton, Australia.
Department of Upper Gastrointestinal and Hepatobiliary Surgery, Monash Health, Clayton, Australia.
ANZ J Surg. 2025 Jul-Aug;95(7-8):1462-1469. doi: 10.1111/ans.70250. Epub 2025 Jul 11.
Evidence shows that high body mass index (BMI) contributes to increased postoperative complications in gastrointestinal surgery and suggests that it may contribute to intraoperative adverse events. We primarily aimed to determine if high BMI results in increased intraoperative adverse events in liver resections using the ClassIntra classification.
A retrospective audit of liver resections under a single adult Hepatobiliary unit was performed from February 2018 to October 2023. We compared intraoperative adverse events and postoperative complications between BMI groups ('Normal/low' BMI < 25, 'Overweight' BMI 25-30 and Obese > 30). Resections were divided by complexity into minor, intermediate and major resections by extent of liver resection.
One hundred and ninety-nine patients were included in the analyses. Higher BMI was associated with a significantly greater proportion of intraoperative complications using the ClassIntra classification (p = 0.022). At least one intraoperative complication was sustained by 33.3% and 38.2% of overweight and obese patients, respectively, compared to 19.1% in normal/low weight individuals. There were no differences in other intraoperative or postoperative outcomes or complications with a higher BMI, including estimated blood loss, morbidity by Clavien-Dindo classification, 30-day readmission or mortality. Multivariate analysis showed that BMI class and diabetes status were significantly related to higher ClassIntra complication level (p = 0.0086).
Higher BMI is associated with increased rates of intraoperative adverse events during liver resection surgery, by measure of ClassIntra classification. Prospective standardised assessment of intraoperative complications is required to confirm these findings.
证据表明，高体重指数（BMI）会导致胃肠手术术后并发症增加，并提示其可能导致术中不良事件。我们的主要目的是确定高BMI是否会导致使用ClassIntra分类法的肝切除术中不良事件增加。
对2018年2月至2023年10月在单一成人肝胆科进行的肝切除术进行回顾性审计。我们比较了不同BMI组（“正常/低”BMI<25、“超重”BMI 25-30和“肥胖”>30）的术中不良事件和术后并发症。根据肝切除范围，将切除术按复杂程度分为小、中、大三类。
199例患者纳入分析。使用ClassIntra分类法，较高的BMI与术中并发症比例显著增加相关（p=0.022）。超重和肥胖患者中分别有33.3%和38.2%至少发生了一次术中并发症，而正常/低体重个体中这一比例为19.1%。较高BMI患者在其他术中或术后结局及并发症方面没有差异，包括估计失血量、Clavien-Dindo分类法的发病率、30天再入院率或死亡率。多变量分析显示，BMI类别和糖尿病状态与较高的ClassIntra并发症水平显著相关（p=0.0086）。
通过ClassIntra分类法衡量，较高的BMI与肝切除手术中术中不良事件发生率增加相关。需要进行前瞻性标准化的术中并发症评估以证实这些发现。
