Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
What is the target body mass index for elective Hartmann reversal? A National Surgical Quality Improvement Program analysis using stratum-specific likelihood ratios.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wu George L, Parel Philip M, Zeller Matthew, Wetherell Joseph, Luo Jonathan, Nasseri Yosef, Wolf Joshua H
Аннотация
BACKGROUND: Obesity is associated with adverse outcomes after Hartmann reversal, but there are no procedure-specific, evidence-based body mass index (BMI) targets for elective reversal. We identified data-driven BMI thresholds associated with 30-day morbidity.
METHODS: A retrospective cohort study of adults undergoing elective Hartmann reversal in the American College of Surgeons National Surgical Quality Improvement Program database (2015-2023) was conducted using Current Procedural Terminology codes 44626 and 44227. Stratum-specific likelihood ratio analysis identified risk-distinct BMI strata for any 30-day complication. Multivariable regression evaluated the association of these strata with any complication, serious complication, any surgical site infection, and mortality, adjusting for demographics, comorbidities, operative time, and operative approach.
RESULTS: A total of 16,027 patients met the inclusion criteria. Stratum-specific likelihood ratio analysis identified 3 risk-distinct BMI strata: 18.5 to 33.9 kg/m2 (n = 12,885), 34.0 to 49.9 kg/m2 (n = 3021), and ≥50.0 kg/m2 (n = 121). In adjusted analyzes, patients with a BMI of 34.0 to 49.9 had a 38% increase in the odds of any postoperative complication (odds ratio [OR], 1.38; 95% CI, 1.23-1.54; P <.001), whereas those with a BMI ≥ 50.0 had more than double the odds (OR, 2.54; 95% CI, 1.69-3.81; P <.001). A similar gradient was observed for serious complications (OR, 1.31 and 2.73, respectively; both P <.001) and for any surgical site infection (OR, 1.51; P <.001 and OR, 2.10; P =.002). Mortality was rare.
CONCLUSION: Stratum-specific likelihood ratio analysis identified data-driven BMI thresholds that stratify postoperative morbidity after Hartmann reversal. These thresholds could serve as evidence-based weight-loss targets for surgeons and patients to aim for during preoperative optimization.
METHODS: A retrospective cohort study of adults undergoing elective Hartmann reversal in the American College of Surgeons National Surgical Quality Improvement Program database (2015-2023) was conducted using Current Procedural Terminology codes 44626 and 44227. Stratum-specific likelihood ratio analysis identified risk-distinct BMI strata for any 30-day complication. Multivariable regression evaluated the association of these strata with any complication, serious complication, any surgical site infection, and mortality, adjusting for demographics, comorbidities, operative time, and operative approach.
RESULTS: A total of 16,027 patients met the inclusion criteria. Stratum-specific likelihood ratio analysis identified 3 risk-distinct BMI strata: 18.5 to 33.9 kg/m2 (n = 12,885), 34.0 to 49.9 kg/m2 (n = 3021), and ≥50.0 kg/m2 (n = 121). In adjusted analyzes, patients with a BMI of 34.0 to 49.9 had a 38% increase in the odds of any postoperative complication (odds ratio [OR], 1.38; 95% CI, 1.23-1.54; P <.001), whereas those with a BMI ≥ 50.0 had more than double the odds (OR, 2.54; 95% CI, 1.69-3.81; P <.001). A similar gradient was observed for serious complications (OR, 1.31 and 2.73, respectively; both P <.001) and for any surgical site infection (OR, 1.51; P <.001 and OR, 2.10; P =.002). Mortality was rare.
CONCLUSION: Stratum-specific likelihood ratio analysis identified data-driven BMI thresholds that stratify postoperative morbidity after Hartmann reversal. These thresholds could serve as evidence-based weight-loss targets for surgeons and patients to aim for during preoperative optimization.