Obesity does not increase morbidity of laparoscopic cholecystectomy
Obesity does not increase morbidity of laparoscopic cholecystectomy
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DOI：
10.1016/j.jss.2014.02.014
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发表时间：
2014-08-01
影响因子：
2.2
通讯作者：
Pomp, Alfons
中科院分区：
文献类型：
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作者：
Afaneh, Cheguevara;Abelson, Jonathan;Pomp, Alfons
背景：肥胖历来是手术发病率的积极预测因素，尤其是在病态肥胖者中。我们研究的目的是比较肥胖患者行腹腔镜胆囊切除术（LC）的结局。方法：我们回顾性分析了2008年1月至2011年8月期间因各种病理原因行LC的1382例连续患者。根据世界卫生组织对肥胖的定义对患者进行分层：非肥胖（体重指数[BMI] < 30 kg/m2）、肥胖I级（BMI 30-34.9 kg/m2）、肥胖II级（BMI 35-39.9 kg/m2）和肥胖III级（BMI ≥ 40 kg/m2）。主要终点是转换率和手术发病率。次要终点是住院时间。结果：肥胖II型和III型组中女性明显多于男性（P = 0.0002）。肥胖I、II和III组的美国麻醉医师协会评分显著高于非肥胖组（分别为P < 0.05、P < 0.01和P < 0.0001）。多变量分析（MVA）中转换的独立预测因素包括年龄（P 0.01）、急性胆囊炎（P = 0.03）、手术时间（P < 0.0001）、失血量（P <0.0001）和接受过研究员培训的外科医生（P < 0.0001）。MVA术中并发症的独立预测因素包括年龄（P = 0.009）、白色患者（P = 0.009）、既往手术（P = 0.001）、手术时间（P < 0.0001）和失血量（P 0.01）。MVA术后并发症的独立预测因素包括美国麻醉医师协会评分（P < 0.0001）、急性胆囊炎（P < 0.0001）和术后并发症（P < 0.0001）。BMI不是转换或手术发病率的预测因子。四组之间的住院时间没有显着差异。结论：这项研究表明，整体转换率和手术发病率是相对较低的LC，即使在肥胖和病态肥胖患者。(C)2014爱思唯尔公司All rights reserved.
Background: Obesity has historically been a positive predictor of surgical morbidity, especially in the morbidly obese. The purpose of our study was to compare outcomes of obese patients undergoing laparoscopic cholecystectomy (LC).Methods: We reviewed 1382 consecutive patients retrospectively who underwent LC for various pathologies from January 2008 to August 2011. Patients were stratified based on the World Health Organization definitions of obesity: nonobese (body mass index [BMI] < 30 kg/m(2)), obesity class I (BMI 30-34.9 kg/m(2)), obesity class II (BMI 35-39.9 kg/m(2)), and obesity class III (BMI >= 40 kg/m(2)). The primary end points were conversion rates and surgical morbidity. The secondary end point was length of stay.Results: There were significantly more females in the obesity II and III groups (P = 0.0002). American Society of Anesthesiologists scores were significantly higher in the obesity I, II, and III groups compared with the nonobese (P < 0.05; P < 0.01; and P < 0.0001, respectively). Independent predictors of conversion on multivariate analysis (MVA) included age (P 0.01), acute cholecystitis (P = 0.03), operative time (P < 0.0001), blood loss (P < 0.0001), and fellowship-trained surgeons (P < 0.0001). Independent predictors of intraoperative complications on MVA included age (P = 0.009), white patients (P = 0.009), previous surgery (P = 0.001), operative time (P < 0.0001), and blood loss (P 0.01). Independent predictors of postoperative complications on MVA included American Society of Anesthesiologists score (P < 0.0001), acute cholecystitis (P < 0.0001), and a postoperative complication(P < 0.0001). BMI was not a predictor of conversions or surgical morbidity. Length of stay was not significantly different between the four groups.Conclusions: This study demonstrates that overall conversion rates and surgical morbidity are relatively low following LC, even in obese and morbidly obese patients. (C) 2014 Elsevier Inc. All rights reserved.