非心脏、非产科手术的成人BMI与术后肺部并发症的关系：一项回顾性队列研究

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia Pub Date : 2025-02-18 DOI:10.1111/anae.16573

Pei-Pei Qin, Zhi-Qiao Wang, Ling Liu, Qiu-Ju Xiong, Dan Liu, Su Min, Ke Wei

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引用次数: 0

摘要

导言：关于BMI对术后不良事件的影响，已有相互矛盾的结果报道。本研究的目的是探讨成人非心脏、非产科外科手术后BMI与肺部并发症之间的关系。方法：这项大规模回顾性研究包括125082名成年人，他们在2019年至2023年期间在一所大学附属三级医院接受了手术。主要终点是术后肺部并发症的发生率。采用多变量logistic回归分析、亚组分析、敏感性分析和限制性三次样条分析评估BMI与术后肺部并发症的关系。结果：6671例患者（5.3%）出现一种或多种术后肺部并发症。调整混杂因素后，与体重正常（BMI 18.5-24.9 kg.m-2）的患者相比，体重过轻（BMI -2）的患者术后肺部并发症风险增加（OR 1.24, 95%CI 1.12-1.39, p -2）或1级肥胖（BMI 30.0-34.9 kg.m-2）的患者术后肺部并发症风险较低（OR 0.88, 95%CI 0.83-0.94, p -2），术后肺部并发症风险与体重正常（OR 1.23, p -2）的患者相似。95%CI 0.91-1.66, p = 0.17)。BMI与术后肺部并发症发生率呈j型相关，BMI为27.4 kg.m-2时风险最低。讨论：与体重正常的患者相比，超重或1级肥胖患者接受非心脏、非产科手术的术后肺部并发症的风险反而较低。这些发现可能与关于手术风险和肥胖的传统假设相矛盾，强调需要重新评估BMI与术后肺部并发症之间的关系。

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The association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgery: a retrospective cohort study.

Introduction: Conflicting results have been reported regarding the influence of BMI on postoperative adverse events. The aim of this study was to investigate the association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgical procedures.

Methods: This large-scale retrospective study included 125,082 adults who underwent surgery at a university-affiliated tertiary care hospital between 2019 and 2023. The primary endpoint was the incidence of postoperative pulmonary complications. Multivariable logistic regression analyses, subgroup analyses, sensitivity analyses and restricted cubic splines were used to assess the association between BMI and postoperative pulmonary complications.

Results: A total of 6671 patients (5.3%) developed one or more postoperative pulmonary complications. After adjusting for confounders, compared with those patients with a normal weight (BMI 18.5-24.9 kg.m^-2), patients who were underweight (BMI < 18.5 kg.m^-2) had an increased risk of postoperative pulmonary complications (OR 1.24, 95%CI 1.12-1.39, p < 0.001). Patients who were overweight (BMI 25.0-29.9 kg.m^-2) or living with class 1 obesity (BMI 30.0-34.9 kg.m^-2) had a lower risk of postoperative pulmonary complications (OR 0.88, 95%CI 0.83-0.94, p < 0.001 and OR 0.82, 95%CI 0.70-0.96; p = 0.01, respectively). Patients living with obesity class 2/3 (BMI ≥ 35 kg.m^-2) had a similar risk of postoperative pulmonary complications as patients with a normal weight (OR 1.23, 95%CI 0.91-1.66, p = 0.17). There was a J-shaped association between BMI and incidence of postoperative pulmonary complications with the lowest risk at a BMI of 27.4 kg.m^-2.

Discussion: Patients who were overweight or living with class 1 obesity undergoing non-cardiac, non-obstetric surgery had paradoxically lower risks of postoperative pulmonary complications compared with those of a normal weight. These findings may contradict traditional assumptions about surgical risk and obesity, highlighting the need to re-evaluate the relationship between BMI and postoperative pulmonary complications.

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来源期刊

Anaesthesia 医学-麻醉学

CiteScore

21.20

自引率

9.30%

发文量

300

审稿时长

6 months

期刊介绍： The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.