Abstract：
BACKGROUND: Obesity is increasingly prevalent both nationwide and in the emergency general surgery (EGS) population. While previous studies have shown that obesity may be protective against mortality following EGS procedures, the association between body mass index (BMI) and postoperative outcomes, as well as intraoperative decision-making, remains understudied.
METHODS: The National Surgical Quality Improvement Program 2015-2019 database was used to identify all adult patients undergoing an open abdominal or abdominal wall procedure for EGS conditions. Our outcomes included 30-d postoperative mortality, composite 30-d morbidity, delayed fascial closure, reoperation, operative time, and hospital length of stay (LOS). Multivariable logistic regression models were used to explore the association between BMI and each outcome of interest while adjusting for patient demographics, comorbidities, laboratory tests, preoperative and intraoperative variables.
RESULTS: We identified 78,578 patients, of which 3121 (4%) were categorized as underweight, 23,661 (30.1%) as normal weight, 22,072 (28.1%) as overweight, 14,287 (18.2%) with class I obesity, 7370 (9.4%) with class II obesity, and 8067 (10.3%) with class III obesity. Class III obesity was identified as a risk factor for 30-d postoperative morbidity (adjusted odds ratio 1.14, 95% CI, 1.03-1.26, P < 0.01). An increase in obesity class was also associated with a stepwise increase in the risk of undergoing delayed fascial closure, experiencing a prolonged operative time, and having an extended LOS.
CONCLUSIONS: Obesity class was associated with an increase in delayed fascial closure, longer operative time, higher reoperation rates, and extended hospital LOS. Further studies are needed to explore how a patient\'s BMI impacts intraoperative factors, influences surgical decision-making, and contributes to hospital costs.
METHODS: The National Surgical Quality Improvement Program 2015-2019 database was used to identify all adult patients undergoing an open abdominal or abdominal wall procedure for EGS conditions. Our outcomes included 30-d postoperative mortality, composite 30-d morbidity, delayed fascial closure, reoperation, operative time, and hospital length of stay (LOS). Multivariable logistic regression models were used to explore the association between BMI and each outcome of interest while adjusting for patient demographics, comorbidities, laboratory tests, preoperative and intraoperative variables.
RESULTS: We identified 78,578 patients, of which 3121 (4%) were categorized as underweight, 23,661 (30.1%) as normal weight, 22,072 (28.1%) as overweight, 14,287 (18.2%) with class I obesity, 7370 (9.4%) with class II obesity, and 8067 (10.3%) with class III obesity. Class III obesity was identified as a risk factor for 30-d postoperative morbidity (adjusted odds ratio 1.14, 95% CI, 1.03-1.26, P < 0.01). An increase in obesity class was also associated with a stepwise increase in the risk of undergoing delayed fascial closure, experiencing a prolonged operative time, and having an extended LOS.
CONCLUSIONS: Obesity class was associated with an increase in delayed fascial closure, longer operative time, higher reoperation rates, and extended hospital LOS. Further studies are needed to explore how a patient\'s BMI impacts intraoperative factors, influences surgical decision-making, and contributes to hospital costs.
摘要：
背景：肥胖在全国范围内和急诊普外科（EGS）人群中越来越普遍。虽然以前的研究表明，肥胖可以防止EGS手术后的死亡，体重指数（BMI）与术后结局之间的关系，以及术中决策，仍未研究。
方法：国家外科质量改进计划2015-2019数据库用于识别所有接受腹部或腹壁开放手术治疗EGS条件的成年患者。我们的结果包括术后30d死亡率，复合30天发病率，延迟筋膜闭合,再操作,手术时间,住院时间（LOS）。使用多变量逻辑回归模型来探索BMI与每个目标结果之间的关联，同时根据患者的人口统计学进行调整。合并症,实验室测试,术前和术中变量。
结果：我们确定了78,578名患者，其中3121人(4%)被归类为体重不足，23,661（30.1%）为正常体重，22,072（28.1%）为超重，14,287（18.2%）患有I类肥胖，7370（9.4％）患有II类肥胖症，和8067（10.3％）患有III类肥胖。III类肥胖被确定为术后30天发病率的危险因素(校正比值比1.14,95%CI,1.03-1.26,P<0.01)。肥胖类别的增加也与经历延迟筋膜闭合的风险逐步增加有关。经历了长时间的手术，并有一个扩展的LOS。
结论：肥胖等级与延迟筋膜闭合的增加有关，更长的手术时间，更高的再手术率，和扩展的医院LOS。需要进一步的研究来探索患者的BMI如何影响术中因素，影响手术决策，并增加医院费用。
方法：国家外科质量改进计划2015-2019数据库用于识别所有接受腹部或腹壁开放手术治疗EGS条件的成年患者。我们的结果包括术后30d死亡率，复合30天发病率，延迟筋膜闭合,再操作,手术时间,住院时间（LOS）。使用多变量逻辑回归模型来探索BMI与每个目标结果之间的关联，同时根据患者的人口统计学进行调整。合并症,实验室测试,术前和术中变量。
结果：我们确定了78,578名患者，其中3121人(4%)被归类为体重不足，23,661（30.1%）为正常体重，22,072（28.1%）为超重，14,287（18.2%）患有I类肥胖，7370（9.4％）患有II类肥胖症，和8067（10.3％）患有III类肥胖。III类肥胖被确定为术后30天发病率的危险因素(校正比值比1.14,95%CI,1.03-1.26,P<0.01)。肥胖类别的增加也与经历延迟筋膜闭合的风险逐步增加有关。经历了长时间的手术，并有一个扩展的LOS。
结论：肥胖等级与延迟筋膜闭合的增加有关，更长的手术时间，更高的再手术率，和扩展的医院LOS。需要进一步的研究来探索患者的BMI如何影响术中因素，影响手术决策，并增加医院费用。
