儿童腺样体扁桃体切除术后肥胖与呼吸系统并发症：一项关于高危合并症效应修饰的全国性分析

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中文摘要

目的： 评估接受日间腺样体扁桃体切除术、扁桃体切除术或腺样体切除术的儿童中肥胖与围手术期呼吸不良事件（PRAEs）之间的关联，并评估高危合并症是否修饰这种关联。
方法： 对2016-2022年医疗成本与利用项目全国日间手术样本（NASS）进行回顾性横断面分析。纳入所有接受这些手术的18岁以下患者的就诊记录。肥胖和PRAEs通过ICD-10-CM诊断代码识别。调查加权逻辑回归估计调整后的比值比（aORs），控制年龄、性别、合并症、支付方、收入四分位数、医院特征和日历年。交互项检验唐氏综合征、先天性心脏病、颅面畸形、哮喘、镰状细胞病和地中海贫血的效应修饰。
结果： 在1,495,718例未加权就诊（1,997,730例加权）中，65,983例（3.30%）带有肥胖诊断。PRAEs在肥胖儿童中发生率为0.77%，而非肥胖儿童为0.59%（p < .001）。未调整时，肥胖与PRAE odds增加31%相关（OR，1.31；95% CI，1.14-1.50）。调整年龄、性别和临床合并症后，由于年龄的负混杂，关联增强（aOR，1.85；95% CI，1.62-2.12），并在完全调整模型中保持显著（aOR，1.62；95% CI，1.42-1.86）。发现肥胖-哮喘的亚乘法交互作用（p = .009）：观察到的联合效应（OR，2.07）低于预期的乘法联合效应2.89。未出现其他显著交互作用。
结论： 在这个全国性日间队列中，肥胖独立增加了PRAE风险。亚乘法肥胖-哮喘交互作用表明风险通路部分重叠，并支持对患有合并哮喘的肥胖儿童降低延长术后观察的门槛。

英文摘要

OBJECTIVE: To evaluate the association between obesity and perioperative respiratory adverse events (PRAEs) in children undergoing ambulatory adenotonsillectomy, tonsillectomy, or adenoidectomy, and to assess whether high-risk comorbidities modify this association.
METHODS: Retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Nationwide Ambulatory Surgery Sample (NASS), 2016-2022. All encounters for patients younger than 18 years undergoing these procedures were included. Obesity and PRAEs were identified by ICD-10-CM diagnosis codes. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) controlling for age, sex, comorbidities, payer, income quartile, hospital characteristics, and calendar year. Interaction terms tested effect modification by Down syndrome, congenital heart disease, craniofacial anomalies, asthma, sickle cell disease, and thalassemia.
RESULTS: Among 1 495 718 unweighted encounters (1 997 730 weighted), 65 983 (3.30%) carried an obesity diagnosis. PRAEs occurred in 0.77% of obese versus 0.59% of non-obese children (p < .001). Unadjusted, obesity was associated with 31% higher PRAE odds (OR, 1.31; 95% CI, 1.14-1.50). After adjustment for age, sex, and clinical comorbidities, the association strengthened due to negative confounding by age (aOR, 1.85; 95% CI, 1.62-2.12) and remained significant in the fully adjusted model (aOR, 1.62; 95% CI, 1.42-1.86). A sub-multiplicative obesity-asthma interaction was identified (p = .009): the observed combined effect (OR, 2.07) fell below the expected multiplicative joint effect of 2.89. No other significant interactions emerged.
CONCLUSION: Obesity independently elevated PRAE risk in this national ambulatory cohort. The sub-multiplicative obesity-asthma interaction indicates partially overlapping risk pathways and supports a lower threshold for extended postoperative observation in obese children with comorbid asthma.