Canales Cecilia, Anderson Myles, Elashoff David, Grogan Tristan, Russell Marcia M, Duval Victor, Whittington Robert, Cannesson Maxime, Sarkisian Catherine
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles.
Charles R. Drew University of Medicine and Science, Los Angeles, California.
JAMA Netw Open. 2025 Aug 1;8(8):e2528875. doi: 10.1001/jamanetworkopen.2025.28875.
High body mass index (BMI) has been associated with increased postoperative complications including mortality in the general population, leading many perioperative clinicians to recommend preoperative lifestyle modifications aimed at achieving normal body weight. However, aging introduces physiological changes associated with frailty, such as altered body composition, fat redistribution, and stature reduction due to height loss, all of which may modify the association between BMI and surgical outcomes in older adults.
To determine if a higher BMI in older adults who are undergoing major elective surgery is associated with rates of all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study of adults aged 65 years or older presenting for surgery from February 2019 to January 2022 at a preoperative clinic before planned major elective surgery at a large academic Center in Southern California.
Body mass index.
Postoperative outcomes included all-cause 30-day and 1-year mortality, postoperative delirium, discharge disposition, and complications classified using the Clavien-Dindo system.
The study included 414 older adults undergoing major elective surgery with a mean (SD) age of 75.9 (7.2) years; 54.8% (95% CI, 50.2%-60.4%) of the cohort were female. The prevalence of frailty was 24.2% (95% CI, 20.3%-28.5%), and 37.0% (95% CI, 32.6%-41.8%) of the cohort was prefrail. The overall 30-day all-cause mortality rate was 11.0% (95% CI, 8.5%-14.5%). Patients categorized as overweight (BMI, 25.0-29.9; calculated as weight in kilograms divided by height in meters squared) had the lowest 30-day all-cause mortality rate, with a significant risk reduction compared with patients with a normal BMI (18.5-24.9) (1 of 128 patients [0.8%] vs 25 of 133 patients [18.8%]; odds ratio [OR], 0.03; 95% CI, 0.01-0.26; P = .001). This association remained significant in the multivariable logistic regression model after adjusting for potential confounders (OR, 0.14; 95% CI, 0.06-0.34; P < .001). Patients categorized as underweight (BMI <18.5) had the highest 30-day all-cause mortality rate (15 of 20 patients [75.0%]; 95% CI, 55.0%-90.0%).
In this observational cohort study of older adults undergoing major elective surgery, being overweight was associated with lower odds of 30-day all-cause mortality. These findings suggest that traditional weight loss recommendations based on achieving normal BMI may need to be reevaluated for this population.
高体重指数（BMI）与普通人群术后并发症增加（包括死亡率）相关，这使得许多围手术期临床医生建议进行术前生活方式调整，以达到正常体重。然而，衰老会引发与虚弱相关的生理变化，如身体成分改变、脂肪重新分布以及因身高降低导致的身材变矮，所有这些都可能改变老年人中BMI与手术结局之间的关联。
确定接受大型择期手术的老年人中较高的BMI是否与全因死亡率相关。
设计、背景和参与者：对2019年2月至2022年1月在南加州一家大型学术中心的术前诊所就诊、计划接受大型择期手术的65岁及以上成年人进行队列研究。
体重指数。
术后结局包括30天和1年全因死亡率、术后谵妄、出院情况以及使用Clavien-Dindo系统分类的并发症。
该研究纳入了414名接受大型择期手术的老年人，平均（标准差）年龄为75.9（7.2）岁；队列中54.8%（95%置信区间，50.2%-60.4%）为女性。虚弱的患病率为24.2%（95%置信区间，20.3%-28.5%），队列中37.0%（95%置信区间，32.6%-41.8%）为衰弱前期。总体30天全因死亡率为11.0%（95%置信区间，8.5%-14.5%）。被归类为超重（BMI，25.0-29.9；计算方法为体重（千克）除以身高（米）的平方）的患者30天全因死亡率最低，与BMI正常（18.5-24.9）的患者相比，风险显著降低（128例患者中的1例[0.8%] vs 133例患者中的25例[18.8%]；比值比[OR]，0.03；95%置信区间，0.01-0.26；P = 0.001）。在调整潜在混杂因素后的多变量逻辑回归模型中，这种关联仍然显著（OR，0.14；95%置信区间，0.06-0.34；P < 0.001）。被归类为体重过轻（BMI < 18.5）的患者30天全因死亡率最高（20例患者中的15例[75.0%]；95%置信区间，55.0%-90.0%）。
在这项针对接受大型择期手术的老年人的观察性队列研究中，超重与30天全因死亡率较低的几率相关。这些发现表明，对于该人群，基于达到正常BMI的传统减肥建议可能需要重新评估。
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