Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy

Gao, Hua; Feng, Hao; Li, Bin; Lin, Junping; Yang, Jing; Zhu, Duojie; Ji, Tao

doi:10.1097/md.0000000000011091

Cited by 12 publications

(11 citation statements)

References 36 publications

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“…It is suggested that a longer esophageal invasion could cause technical difficulties in the transhiatal procedure, which were found only in the transhiatal gastrectomy group. Additionally, previous studies have shown that patients with a high BMI are likely to have a higher incidence of postoperative complications after esophagectomy [20,21]. On the other hand, a high BMI was not related to a higher incidence of postoperative complications in gastrectomy according to several previous studies [22,23].…”

Section: Discussionmentioning

confidence: 83%

Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study

et al. 2021

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Background Esophagogastric junction (EGJ) cancers are resected thorough esophagectomy or gastrectomy, with the incidence of postoperative complications influenced by the chosen procedure. Methods In this prospective nationwide multicenter study, patients with cT2-T4 EGJ cancers were enrolled before surgery. Based on the protocol, surgeons performed a transthoracic esophagectomy (TTE) or a transhiatal gastrectomy (THG) and dissected all lymph nodes prespecified as the standardized procedure. Postoperative complications were correlated with the clinical factors in each procedure. Results A total of 345 patients were eligible for this study. TTE and THG were performed in 120 and 225 patients, respectively. Complications of Clavien-Dindo ≥ Grade II were found in 115/345 (33.3%) patients. Recurrent laryngeal nerve palsy was found only in the TTE group (p < 0.001). The incidence of other complications was not significantly different between the two groups. High body mass index (BMI) in the TTE group, male sex, and longer esophageal invasion in the THG group were significantly correlated with complications ≥ Grade II (p = 0.049, 0.037, and 0.019, respectively). Anastomotic leakage was most frequently observed (12.2%). Tumor size in the THG group (p = 0.02) was significantly associated with leakage. All six patients with ≥ Grade IV leakage underwent THG, whereas, none of the patients in the TTE group had leakage ≥ Grade IV (2.7% vs. 0%, p = 0.096). Conclusions Surgical resection should be performed with utmost care, particularly in patients with a high BMI undergoing TTE, and in patients with larger tumors, longer esophageal invasion, or male patients undergoing THG.

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Section: Discussionmentioning

confidence: 83%

Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study

et al. 2021

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“…Most patients (>95%) had an open approach to their oesophagectomy, which may impact LOS (Biere et al 2012, Nason 2016). The average body mass index (BMI) of our sample was high, which has been associated with increased incidence of some postoperative complications (Gao et al 2018, Mengardo et al 2018), which also impact LOS. Our patients live in a rural state and often have poor access to medical care.…”

Section: Discussionmentioning

confidence: 96%

Preoperative nutritional counselling in patients undergoing oesophagectomy

Gongola

Reif

Cosgrove

et al. 2021

Journal of Perioperative Practice

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Background Patients undergoing surgery for oesophageal cancer are at high risk of malnutrition due to pathology and neoadjuvent therapy. This study sought to determine if oesophageal cancer patients undergoing oesophagectomy achieve superior clinical outcomes when preoperative nutritional counselling is performed. Methods Oesophageal cancer patients undergoing oesophagectomy were retrospectively divided into cohorts based on those who received ( n = 48) and did not receive ( n = 58) preoperative nutritional counselling. We compared weight loss, length of stay, 30-day readmission related to nutrition or feeding tube problems, and 90-day mortality. Results Per cent weight loss was less in patients who received preoperative nutritional counselling. There was a trend toward decreased mean length of stay and there were fewer readmissions for feeding tube-related complications in patients who received counselling. Conclusions Nutritional counselling before surgery may lead to decreased weight loss and reduced readmissions for feeding tube-related complications in patients with oesophageal cancer undergoing oesophagectomy.

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“…Based on univariate analyses, it was found that patients who did not return the survey were slightly older, had higher BMI and ASA scores, and were more likely to be functionally dependent prior to surgery. These patients have traditionally had poorer outcomes following surgery suggesting that missing their input could bias survey outcomes [ 15 – 17 ]. Additionally, survey non-responders were found to be more non-white.…”

Section: Discussionmentioning

confidence: 99%

Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty

et al. 2021

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Introduction The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients’ satisfaction of their hospital experience. A minority of discharged patients return the survey. Underlying bias among who ultimately returns the survey (non-response bias) after total knee arthroplasty (TKA) may affect results of the survey. Thus, the objective of the current study is to assess the relationship between patient characteristics and postoperative outcomes on HCAHPS survey nonresponse. Methods All adult patients at a single institution undergoing inpatient, elective, primary TKA between February 2013 and May 2020 were selected for analysis. Following discharge, all patients had been mailed the HCAHPS survey. The primary outcome analyzed in the current study is survey return. Patient characteristics, surgical variables, and 30-day postoperative outcomes were analyzed. Univariate and multivariate analyses were performed to identify factors independently associated with return of the HCAHPS survey. Results Of 4,804 TKA patients identified, 1,498 (31.22%) returned HCAHPS surveys. On multivariate regression analyses controlling for patient factors, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (ASA score of 4 or higher, OR = 2.37; P<0.001), and be partially or totally dependent (OR = 2.37; P = 0.037). Similarly, patients who did not return the survey were more likely to have had a readmission (OR = 1.94; P<0.001), be discharged to a place other than home (OR = 1.52; P<0.001), or stay in the hospital for longer than 3 days (OR = 1.43; P = 0.004). Discussion Following TKA, HCAHPS survey response rate was only 31.22% and completion of the survey was associated with several demographic and postoperative variables. These findings suggest that HCAHPS survey results capture a non-representative fraction of the true TKA patient population. This bias is necessary to consider when using HCAHPS survey results as a metric for quality of healthcare and federal reimbursement rates.

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Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy

Cited by 12 publications

References 36 publications

Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study

Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study

Preoperative nutritional counselling in patients undergoing oesophagectomy

Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty

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