| Titre : | Obesity in general elective surgery. Commentary. (2003) |
| Auteurs : | Daniel Dindo ; Pierre-Alain CLAVIEN ; MASON (Edward-E) : USA. Department of Surgery. University of Iowa Hospitals and Clinics. Iowa City. IO. ; Markus-K MULLER ; Markus WEBER ; Department of Visceral Surgery and Transplantation. University Hospital Zurich. Zurich. CHE |
| Type de document : | Article |
| Dans : | Lancet (The) (vol. 361, n° 9374, 2003) |
| Pagination : | 2001-2035 (6p.) |
| Langues: | Anglais |
| Mots-clés : | Obésité ; Chirurgie ; Pronostic ; Epidémiologie ; Facteur risque ; Complication ; Homme ; Maladie nutrition |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 3zzKR0xj. Diffusion soumise à autorisation]. Background Obese patients are generally believed to be at a higher risk for surgery than those who are not obese, although convincing data are lacking. Methods We prospectively investigated a cohort of 6336 patients undergoing general elective surgery at our institution to assess whether obesity affects the outcome of surgery. Exclusion criteria were emergency, vascular, thoracic, and bariatric operations ; transplantation procedures ; patients under immunosuppression ; and operations done under local anaesthesia. Postoperative morbidity was analysed for non-obese and obese patients (body-mass index<30 kg/m2 vs>=30 kg/m2). Obesity was further stratified into mild obesity (30.0-34.9 kg/m2) and severe obesity (>=35 kg/m2). Risk factors were analysed with univariate and multivariate models. Findings The cohort consisted of 6336 patients, of whom 808 (13%) were obese, 569 (9%) were mildly obese, and 239 (4%) had severe obesity. The morbidity rates in patients who were obese compared with those who were not were much the same (122 [15.1% ] of 808 vs 901 [16.3% ] of 5528 ; p=0.26), with the exception of an increased incidence of wound infections after open surgery in patients who were obese (17 [4% ] of 431 vs 92 [3% ] of 3555, p=0.03). Incidence of complications did not differ between patients who were mildly obese (91 [16.0% ] of 569), severely obese (36 [15.1% ] of 239), and non-obese (901 [16.3% ] of 5528 ; p=0.19). In multivariate regression analyses, obesity was not a risk factor for development of postoperative complications. Of note, the additional medical resource use as estimated by a new classification of complications showed no differences between patients who were and were not obese. Interpretation Obesity alone is not a risk factor for postoperative complications. The regressive attitude towards general surgery in obese patients is no longer justified. |
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