Obesity Stratification Predicts Short-Term Complications After Parastomal Hernia Repair.
Obesity Stratification Predicts Short-Term Complications After Parastomal Hernia Repair.
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肥胖分层可预测造口旁疝修补术后的短期并发症。
DOI：
10.1016/j.jss.2022.07.002
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Rajesh,Aashish
中科院分区：
文献类型：
--
作者：
Khan,MustafaTamimAlam;Patnaik,Ronit;Hausman-Cohen,Lee;Panchal,Olivia;Ewart,Mackenzie;Lovely,RehanaSultana;Rajesh,Aashish
引言虽然先前的研究已经记录了接受腹疝和腹股沟疝修补术的肥胖患者的不良结局，但缺乏关于肥胖对造口旁疝（PSH）修补术影响的文献。这项回顾性研究的目的是确定肥胖分层预测PSH repair.Materials和methodsOutcomes从2010年到2020年在美国外科医师学会国家外科手术质量改进计划数据库的择期PSH修复术后并发症的价值进行了分析。患者的人口统计学，术前特征，术后结果进行了比较，使用双变量分析和多变量回归models.ResultsA共2972例患者进行了回顾性分析。多变量回归分析发现，与非肥胖患者相比，肥胖分级≥ II的患者总体上发生并发症的可能性高1.37倍（P= 0.006），发生伤口并发症的可能性高1.55倍（P< 0.001）。该组发生浅表伤口感染的风险也高1.60倍（P= 0.007），发生术后脓毒症的风险高1.63倍（P= 0.044）。肥胖程度≥ II级的患者总住院时间较体重指数<30.0 kg/m2的患者长，而肥胖程度I级的患者总住院时间与体重指数<30.0 kg/m2的患者无明显差异。结论体重指数≥35.0 kg/m2的患者术后并发症发生率较高。本研究的结果将使外科医生能够对PSH修复前可从术前减肥干预中获益的肥胖患者进行分层，并与患者讨论相关风险，以促进知情同意。
IntroductionWhile previous studies have documented adverse outcomes among obese patients undergoing ventral and inguinal hernia repairs, there is a lack of literature regarding the impact of obesity on parastomal hernia (PSH) repair. This retrospective study aims to determine the value of obesity stratification in predicting postoperative complications in patients undergoing PSH repair.Materials and methodsOutcomes of elective PSH repairs from 2010 to 2020 in the American College of Surgeons National Surgical Quality Improvement Program database were analyzed. Patient demographics, preoperative characteristics, and postoperative outcomes were compared using bivariate analysis and multivariable regression models.ResultsA total of 2972 patients were retrospectively analyzed. Multivariable regression found, compared to nonobese patients, patients of obesity class ≥ II were 1.37 times more likely to develop complications overall (P= 0.006) and 1.55 times more likely to develop wound complications (P< 0.001). This group also yielded a 1.60 times higher risk of developing superficial wound infection (P= 0.007) and a 1.63 times greater risk of developing postoperative sepsis (P= 0.044). Total length of stay was longer for patients of obesity class ≥ II but not for obesity class I when compared to patients with body mass index <30.0 kg/m2.ConclusionsPatients with a body mass index ≥35.0 kg/m2are more susceptible to an increased rate of complications after PSH repairs. The findings of this study will allow surgeons to stratify obese patients who would benefit from preoperative weight loss interventions prior to PSH repair and discuss associated risks with patients to facilitate informed consent.
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