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National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA.

美国因良性妇科疾病接受住院子宫切除术的病态肥胖妇女的国家趋势和结局。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14034
  • 作者列表:"Matsuo K","Mandelbaum RS","Nusbaum DJ","Matsuzaki S","Klar M","Roman LD","Wright JD
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. MATERIAL AND METHODS:This is a population-based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509 395 women who underwent hysterectomy for benign gynecological disease: 430 865 (84.6%) non-obese women, 50 435 (9.9%) women with class I-II obesity and 28 095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort-level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient-level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple-group generalized boosted model. RESULTS:The rate of class III obesity increased by 40.4%, higher than the rate of class I-II obesity (22.2%) (both, P < .001). In parallel, cohort-level rates of perioperative complication and prolonged hospitalization for ≥7 days increased by 19.4% and 54%, respectively (P < .001). In a weighted model, class I-II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08-1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28-1.51) had a significantly increased risk of perioperative complications compared with non-obesity. Larger body habitus was associated with higher total charge (median, $35 180, $36 094 and $39 382; all values cited in US dollars) and prolonged admission rate for ≥7 days (2.9%, 3.1% and 3.9%) (both, P < .001). CONCLUSIONS:The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society-based approaches are necessary to reduce the obesity rate and hysterectomy morbidity.

摘要

引言: 在过去的几十年里,美国人口见证了肥胖的流行扩张; 预计到2030年,近50% 的人口将是肥胖的,25% 是病态肥胖。本研究调查了接受良性子宫切除术的病态肥胖女性的趋势、特征和结局。 材料和方法: 这是一项基于人群的回顾性观察研究,查询了2012年1月至2015年9月的全国住院患者样本。研究人群包括509 395名因良性妇科疾病接受子宫切除术的女性: 430 865名 (84.6%) 非肥胖女性,50 435名 (9.9%) I-II级肥胖女性和28 095名 (5.5%) III级肥胖女性。主要结果指标为 (i) 通过分段线性回归和对数转换评估的肥胖和围手术期并发症的队列水平趋势,以及 (ii) 使用多组广义增强模型后,通过广义估计方程评估的身体习惯的患者水平围手术期并发症风险。 结果: ⅲ 类肥胖率增加40.4%,高于 ⅰ-ⅱ 类肥胖率 (22.2%) (均P <.001)。同时,队列水平的围手术期并发症和延长住院时间 ≥ 7天的发生率分别增加了19.4% 和54% (P <.001)。在加权模型中,与非肥胖相比,i-ii类肥胖 (16.4% vs 14.6%,比值比1.15,95% 置信区间1.08-1.21) 和III类肥胖 (19.2% vs 14.6%,比值比1.39,95% 置信区间1.28-1.51) 显著增加了围手术期并发症的风险。较大的体型与较高的总费用 (中位数,$35 180,$36 094和 $39 382; 所有数值以美元引用) 和 ≥ 7天的延长住院率 (2.9%,3.1% 和3.9%) 相关 (两者,P <.001)。 结论: 在美国接受良性子宫切除术的妇女中,肥胖率,尤其是病态肥胖率显著增加。病态肥胖女性的围手术期结局不良,并且病态肥胖女性数量的增加导致围手术期发病率和总费用的增加。国家和社会为基础的方法是必要的,以减少肥胖率和子宫切除术的发病率。

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