Effect of BMI on Outcomes in Proctectomy

Abstract

Background The unique surgical challenges of proctectomy may be amplified in obese patients. We examined surgical outcomes of a large, diverse sample of obese patients undergoing proctectomy. Objective To determine whether increased body mass index is associated with increased complications in proctectomy. Design A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2010 and 2011). Patients Patients undergoing non-emergent proctectomy, excluding rectal prolapse cases. Patients were grouped by body mass index using the World Health Organization (WHO) classification: underweight (body mass index <18.5); normal (18.5-24.9); overweight (25-29.9); class I (30-34.9), class II (35-39.9), and class III (≥40) obesity. Main Outcome Measures We analyzed the effect of pre- and intra-operative factors on 30-day outcomes. Continuous variables were compared with Wilcoxon Rank-Sum tests, proportions with the Fisher's Exact or Chi-squared tests. Logistic regression controlled for the effects of multiple risk factors. Results Among 5570 patients, class I, II, and III obesity were significantly associated with higher rates of overall complications (44.0%, 50.8%, and 46.6%, respectively, vs. 38.1% for normal weight patients; p<0.05). Superficial wound infection was significantly higher in classes I, II, and III (11.6%, 17.8%, and 13%, respectively, vs. 8.0% for normal weight patients; p<0.05).Operative times for all obesity classes were significantly longer than for normal weight patients. On multivariate analysis, an obese body mass index independently predicted complications; odds ratios (95% confidence intervals) were 1.36 (1.14-1.62) for class I obesity, 1.99 (1.54-2.54) for class II, and 1.42 (1.02-1.96) for class III. Limitations Retrospective design with limited follow up. Conclusions Class I, II, and III obese patients were at significantly increased risk for morbidity compared to normal BMI patients. Class II obese patients had the highest rate of complications, a finding that deserves further investigation.

Impact of Body Mass Index on Early Postoperative and Long-Term Outcome after Rectal Cancer Surgery

“…This is in accordance with the results of our multivariate analysis. In contrast to many other studies, our results did not show an increased mortality for underweight patients [3,5,13,15,17]. Adequate selection of patients for surgery and sufficient management of complications in case of their occurrence are possible reasons for this specific result.…”

“…In our study, the physical status (ASA) was worse in those patients, which also showed more comorbidities, especially cardiovascular risk factors and diabetes mellitus (data not shown). These findings are not surprising and have been widely described in the literature [2,[13][14][15].…”

“…In particular, studies with large sample sizes show concordant results [3,5,15] despite the fact that there is literature reporting no(t) significantly increased morbidity rates [14,16]. Increased morbidity in obese patients was mostly due to higher rates of wound infections.…”

“…Increased morbidity in obese patients was mostly due to higher rates of wound infections. The association of obesity and infectious complications has been consistently shown in the literature [2,3,[13][14][15]17]. Options to reduce this increase in morbidity after general surgery and particularly rectal cancer resections include a laparoscopic approach or high inspired oxygen concentrations perioperatively [18,19].…”

Differences in Short-term Outcomes Among Patients Undergoing IPAA With or Without Preoperative Radiation

“…18, 19 Included were non-emergent ileal pouch-anal anastomosis procedures (CPT codes 44158, 44211, 45113, and 44157) performed by general and colorectal surgeons at NSQIP-participating hospitals. Recorded postoperative diagnoses were categorized as cancer, inflammatory bowel disease (IBD), or “other,” when cancer or IBD were not explicitly specified.…”