Purpose

Up to 40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is a well-known risk factor for increased perioperative morbidity, but this risk has never been quantified in IBD patients undergoing abdominal surgery using the United States National Inpatient Sample (NIS) database. This study aims to compare postoperative morbidity between obese and non-obese patients undergoing bowel resection for IBD using recent NIS data.

Methods

Adult patients who underwent bowel resection for IBD from 2015 to 2019 were identified in the NIS using ICD-10-CM coding. Patients were stratified into obese (BMI > 30 kg/m²) and non-obese groups, then propensity score matched (PSM) for demographic, operative, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission healthcare costs, and length of stay (LOS). Univariable and multivariable regressions were utilized.

Results

Overall, 6601 non-obese patients and 671 obese patients were identified. The PSM cohort included 659 patients per group. Obese patients had significantly increased odds of experiencing postoperative in-hospital morbidity (aOR 1.50, 95% CI 1.10–2.03, p = 0.010) compared to non-obese patients. Specifically, obese patients experienced increased gastrointestinal complications (aOR 1.49, 95% CI 1.00–2.24, p = 0.050), and genitourinary complications (aOR 1.71, 95% CI 1.12–2.61, p = 0.013). There were no differences in total admission healthcare costs (MD − $2256.32, 95% CI − 19,144.54–14,631.9, p = 0.79) or LOS (MD 0.16 days, 95% CI − 0.93–1.27, p = 0.77).

Conclusions

Obese IBD patients are at greater risk of postoperative in-hospital morbidity than non-obese IBD patients. This supports targeted preoperative weight loss protocols for IBD patients to optimize surgical outcomes.

中文翻译：

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接受肠切除术的肥胖与非肥胖炎症性肠病患者的短期术后结果：倾向评分匹配分析

目的

高达 40% 的炎症性肠病 (IBD) 患者患有肥胖症。众所周知，肥胖是围手术期发病率增加的一个危险因素，但从未使用美国国家住院患者样本 (NIS) 数据库对接受腹部手术的 IBD 患者的这种风险进行量化。本研究旨在利用最新的 NIS 数据来比较因 IBD 接受肠切除术的肥胖和非肥胖患者的术后发病率。

方法

使用 ICD-10-CM 编码在 NIS 中识别 2015 年至 2019 年因 IBD 接受肠切除术的成年患者。将患者分为肥胖组（BMI > 30 kg/m ²）和非肥胖组，然后针对人口统计学、手术和医院特征进行倾向评分匹配（PSM）。主要结局是术后院内发病率。次要结局包括术后院内死亡率、系统特异性术后并发症、总住院医疗费用和住院时间（LOS）。利用单变量和多变量回归。

结果

总体而言，共确定了 6601 名非肥胖患者和 671 名肥胖患者。PSM 队列每组包括 659 名患者。 与非肥胖患者相比，肥胖患者术后院内发病率显着增加（aOR 1.50，95% CI 1.10-2.03，p = 0.010）。具体来说，肥胖患者胃肠道并发症（aOR 1.49，95% CI 1.00-2.24， p  = 0.050）和泌尿生殖系统并发症（aOR 1.71，95% CI 1.12-2.61，p  = 0.013）增加。总入院医疗费用（MD - 2256.32 美元，95% CI - 19,144.54–14,631.9， p  = 0.79）或 LOS（MD 0.16 天，95% CI - 0.93–1.27，p  = 0.77）没有差异。

结论

与非肥胖 IBD 患者相比，肥胖 IBD 患者术后院内发病的风险更大。这支持 IBD 患者有针对性的术前减肥方案，以优化手术结果。