Background: Obesity is considered a risk factor for postoperative complications as it can limit exposure to the operation field, thereby significantly prolonging surgery time. Obesity-associated comorbidities, such as low-grade systemic inflammation, impaired functional status, and type 2 diabetes, are independent risk factors for impaired anastomotic wound healing and nonsurgical site infections. If obesity itself is an independent risk factor for surgical complications remains controversial, but the reason for this is largely unexplored. Summary: A MEDLINE literature search was performed using the terms: “obesity,” “excess body weight,” and “surgical complications.” Out of 65,493 articles 432 meta-analyses were screened, of which 25 meta-analyses were on the subject. The vast majority of complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown longer operation times, higher blood loss, longer hospital stay for colorectal procedures, oncologic upper gastrointestinal (GI) procedures, and pancreatic surgery. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections. A selection bias in oncologic upper GI patients may have influenced the results with higher BMI in upper GI cancer to be a predictor for better nutritional and performance status. Key Messages: Contrary to bariatric surgery, only limited evidence indicated that site and type of surgery, the approach to the abdominal cavity (laparoscopic vs. open), institutional factors, and the type of perioperative care such as ERAS protocols may play a role in determining postsurgical complications in obese patients. The initial question remains therefore partially unanswered. Large nationwide register-based studies are necessary to better understand which aspects of obesity and its related comorbidities define it as a risk factor for surgical complications.
Visc Med 2021;37:1–11

中文翻译：

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体重超重对术后并发症的影响

背景：肥胖被认为是术后并发症的危险因素，因为它会限制手术区域的暴露，从而显着延长手术时间。肥胖相关的合并症，如低度全身炎症、功能状态受损和 2 型糖尿病，是吻合口伤口愈合受损和非手术部位感染的独立危险因素。肥胖本身是否是手术并发症的独立危险因素仍有争议，但其原因很大程度上尚未被探索。摘要：使用以下术语进行 MEDLINE 文献检索：“肥胖”、“体重过重”和“手术并发症”。在 65,493 篇文章中筛选了 432 篇荟萃分析，其中 25 篇荟萃分析涉及该主题。内脏手术领域的绝大多数复杂肿瘤手术在肥胖患者中显示出较高的并发症发生率。过去 10 至 15 年的荟萃分析一致显示，结直肠手术、肿瘤上消化道 (GI) 手术和胰腺手术的手术时间更长、失血量更高、住院时间更长。有趣的是，这些负面影响似乎不会影响肿瘤患者的总体生存率，尤其是食管切除术后的患者。上消化道肿瘤患者的选择偏倚可能会影响上消化道癌症中较高 BMI 的结果，从而将其作为更好营养和表现状态的预测因子。关键信息：与减肥手术相反，只有有限的证据表明手术部位和类型、腹腔手术方式（腹腔镜与开腹）、机构因素以及围手术期护理类型（例如 ERAS 方案）可能在减重手术中发挥作用。确定肥胖患者的术后并发症。因此，最初的问题仍然部分没有得到解答。为了更好地了解肥胖及其相关合并症的哪些方面将其定义为手术并发症的危险因素，需要进行大规模的全国性登记研究。
内脏医学 2021；37:1–11