Abstract：
Background: The study aimed to identify data-driven body mass index (BMI) thresholds that are associated with varying risk of 30 day complications following adult tonsillectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized to conduct a retrospective cohort analysis of patients undergoing adult tonsillectomy from 2005 to 2019. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven BMI strata that maximized the likelihood of 30 day complications following adult tonsillectomy. Patient demographics and clinical comorbidities were compared using chi-squared analysis and student t tests, where appropriate, for each stratum. Multivariable regression analysis was conducted to confirm association between identified data-driven strata with 30 day complication rates. Results: In total, 44,161 patients undergoing adult tonsillectomy were included in this study. SSLR analysis identified 2 BMI categories: 18 to 45 and 46+. Relative to the 18 to 45 BMI cohort, the 46+ BMI cohort was more likely to have 30 day all-cause complications after surgery [odds ratio (OR): 1.62, P = .007]. Specifically, the 46+ BMI cohort had significantly higher odds for 30 day major medical complications (OR: 2.86, P = .001), pulmonary domain complications (OR: 1.86, P = .041), unplanned reintubation (OR: 2.65, P = .033), and deep vein thrombosis (OR: 6.54, P = .026). Conclusions: We identified a BMI threshold of 46+ that was associated with a significantly increased risk of 30 day all-cause complications following adult tonsillectomy. These BMI strata can guide preoperative planning and risk-stratifying models for predicting 30 day complications in tonsillectomy surgery.
摘要：
背景：该研究旨在确定数据驱动的体重指数（BMI）阈值，这些阈值与成人扁桃体切除术后30天并发症的不同风险相关。方法：利用美国外科医生协会国家外科质量改进计划（ACS-NSQIP）数据库对2005年至2019年接受成人扁桃体切除术的患者进行回顾性队列分析。进行层特异性似然比（SSLR）分析，以确定数据驱动的BMI分层，该分层使成人扁桃体切除术后30天并发症的可能性最大化。使用卡方分析和学生t检验比较患者的人口统计学和临床合并症。在适当的情况下，对于每个阶层。进行了多变量回归分析，以确认识别的数据驱动层与30天并发症发生率之间的关联。结果：总的来说，44,161例接受成人扁桃体切除术的患者被纳入本研究。SSLR分析确定了2个BMI类别：18至45和46+。相对于18至45BMI队列，46+BMI队列更有可能出现术后30天的全因并发症[比值比(OR):1.62,P=.007].具体来说,46+BMI队列发生30天重大医疗并发症的几率显著较高(OR:2.86,P=.001),肺域并发症（OR：1.86，P=.041），非计划再插管（OR：2.65，P=.033），深静脉血栓形成（OR：6.54，P=0.026）。结论：我们确定BMI阈值为46+，这与成人扁桃体切除术后30天全因并发症的风险显着增加有关。这些BMI分层可以指导术前计划和风险分层模型，以预测扁桃体切除术中30天的并发症。
