The Obesity Paradox Body Mass Index and Outcomes in Patients Undergoing Nonbariatric General Surgery
The Obesity Paradox Body Mass Index and Outcomes in Patients Undergoing Nonbariatric General Surgery
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DOI：
10.1097/sla.0b013e3181ad8935
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发表时间：
2009-07-01
影响因子：
9
通讯作者：
Davenport, Daniel L.
中科院分区：
文献类型：
--
作者：
Mullen, John T.;Moorman, Donald W.;Davenport, Daniel L.
目的：我们试图在一个接受非减肥普通外科手术的大型患者队列中研究体重指数（BMI）对30天发病率和死亡率的影响。长期以来，肥胖一直被认为是各种外科手术结果不佳的风险因素，然而，最近对危重病和慢性病患者的研究表明，超重和肥胖患者可能比“正常”患者有更好的结果，方法：对2005年和2006年纳入国家手术质量改进计划参与者使用数据库的118，707例接受非减肥普通手术的患者进行了一项前瞻性、多机构、风险调整的队列研究。使用方差分析、Bonferroni多重比较均值检验和多变量logistic回归分析，在NIH定义的BMI类别中比较结局和风险变量。在调整了所有重要的围手术期风险因素后，根据BMI的死亡风险呈现出倒J形关系，体重过轻和病态肥胖者的比例最高，超重和中度肥胖者的比例最低。超重（比值比，0.85; 95%CI，0.75-0.99）和中度肥胖（比值比，0.73; 95%CI，0.57-0.94）患者的死亡风险显著低于正常体重患者。有一个渐进的增加的可能性的并发症增加BMI类，几乎完全是由于伤口infection.Conclusions的增加率：超重和中度肥胖的患者接受非减肥的普通外科手术有矛盾的“较低”的原油和调整后的死亡率风险与患者相比，在一个“正常”的体重。这一发现与一般人群的观察结果形成对比，证实了该患者人群中存在“肥胖悖论”。
Objective: We sought to examine the effect of body mass index (BMI) on 30-day morbidity and mortality in a large cohort of patients undergoing nonbariatric general surgery.Summary Background Data: Obesity has long been considered a risk factor for poor outcomes from a variety of surgical procedures, yet recent studies of critically and chronically ill patients suggest that overweight and obese patients may paradoxically have better outcomes than "normal" weight patients.Methods: A prospective, multi-institutional, risk-adjusted cohort study of 118,707 patients undergoing nonbariatric general surgery who were included in the National Surgical Quality Improvement Program Participant Use database in 2005 and 2006 was performed. Outcomes and risk variables were compared across NIH-defined BMI class using analysis of variance, Bonferroni multiple comparisons of means tests, and multivariable logistic regression.Results: After adjusting for all significant perioperative risk factors, the risk of death according to BMI exhibited a reverse J-shaped relationship, with the highest rates in the underweight and morbidly obese extremes and the lowest rates in the overweight and moderately obese. Overweight (odds ratio, 0.85; 95% CI, 0.75-0.99) and moderately obese (odds ratio, 0.73; 95% CI, 0.57-0.94) patients had a significantly lower risk of death than normal weight patients. There was a progressive increase in the likelihood of a complication with increasing BMI class, almost entirely due to increasing rates of wound infection.Conclusions: Overweight and moderately obese patients undergoing nonbariatric general surgery have paradoxically "lower" crude and adjusted risks of mortality compared with patients at a "normal" weight. This finding is in contrast to observations from the general population, confirming the existence of an "obesity paradox" in this patient population.