Morbidity and Mortality in Non-Obese Compared to Different Classes of Obesity in Patients Undergoing Transtibial Amputations

Abstract

This study assesses the effect of obesity classes on outcomes and inpatient-hospital-cost compared to non-obese individuals undergoing below-knee amputations (BKAs). Retrospective matched-case controlled study performed on data from NIS Database. We identified three groups: N-Ob (BMI < 29.9 kg/m2; n = 3104), Ob-I/II (BMI: 30 to 39.9 kg/m2; n = 3107), and Ob-III (BMI > 40; n = 3092); matched for gender, comorbidities, tobacco use and elective vs. emergent surgery. Differences in morbidity, mortality, hospital length of stay (LOS), and total inpatient cost were analyzed. Blood loss anemia was more common in Ob-III compared to Ob-I/II patients (OR = 1.2; 95% CI = 1.1–1.4); blood transfusions were less commonly required in Ob-I/II (OR = 0.8; 95% CI = 0.7–0.9) comparatively; Ob-I/II encountered pneumonia less frequently (OR = 0.9; 95% CI = 0.4–0.9), whereas myocardial infarction was more frequent (OR = 7.0; 95% CI = 2.1–23.6) compared to N-Ob patients. Acute renal failure is more frequent in Ob-I/II (OR = 1.2; 95% CI = 1.0–1.3) and Ob-III (OR = 1.8; 95% CI = 1.6–1.9) compared to the N-Ob cohort. LOS was higher in N-Ob (13.1 ± 12.8 days) and Ob-III (13.5 ± 12.4 d) compared to Ob-I/II cohort (11.8 ± 10.1 d; p < 0.001). Mortality was 2.8%, 1.4%, and 2.9% (p < 0.001) for N-Ob, Ob-I/II, and Ob-III, respectively. Hospital charges were $22,025 higher in the Ob-III cohort. Ob-I/II is protective against peri-operative complications and death, whereas hospital cost is substantially higher in Ob-III patients undergoing BKAs.

Weight loss outcomes are generally worse for dogs and cats with class II obesity, defined as > 40% overweight

“…In human medicine, obesity is subdivided into three classes (I, II and III) depending on degree of adiposity as defined by BMI 17 . As mentioned above, morbidity and mortality risk differ amongst classes 22 , with individuals having class III obesity being at greatest risk 23 – 27 . The use of classes, rather than historical descriptions (such as ‘severe’ or ‘morbid’), also avoids the use of stigmatising language, not least given the prevalence and negative consequences of weight stigma both in society 28 and amongst medical professionals 29 .…”

“…This subclassification is somewhat arbitrary but is justified by the fact that health outcomes (e.g. morbidity and mortality risk) differ amongst classes 22 , with the greatest risks for individuals with class III obesity 23 – 27 . Adopting a similar approach might be useful in dogs and cats.…”

Weight loss outcomes are generally worse for dogs and cats with class II obesity, defined as >40% overweight

“…Although somewhat arbitrary, such subclassi cation is justi ed by the fact that health outcomes differ amongst classes. In this respect, morbidity and mortality risk worsen as obesity class increases [22] with the greatest risks for individuals with class III obesity [23][24][25][26][27] . The use of classes, rather than historical descriptions (such as 'severe' or 'morbid'), also avoids the use of stigmatising language, not least given the prevalence and negative consequences of weight stigma both in society [28] and amongst medical professionals [29] .…”

Current Discoveries and Future Implications of Eating Disorders

“…It was reported that obesity is a major risk factor for premature mortality [62,63]. In addition, obesity is associated with a higher risk of developing several chronic conditions that can lead to premature death, such as cardiovascular disease, type II diabetes, and some cancers [64,65]. Based on the scientific evidence presented so far, tailored comprehensive multidisciplinary treatment is essential to provide adequate care for patients with obesity and BED by addressing their overweight and its consequences.…”