The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection

Makino, Tomoki; Shukla, Parul J.; Rubino, Francesco; Milsom, Jeffrey W.

doi:10.1097/sla.0b013e31823dcbf7

Cited by 153 publications

(82 citation statements)

References 46 publications

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“…Patient's body mass index was an independent determinant affecting the length of stay. obesity is often accompanied by comorbidities and may increase operative difficulties, postoperative morbidity, and the length of hospital stay after open and laparoscopic surgery (25).…”

Section: Determinants Affecting Postoperative Hospital Staymentioning

confidence: 99%

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

et al. 2014

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Results: there were no deaths. time to functional recovery was median 2 (interquartile range 2-3) days. the overall 30-day postoperative morbidity was 14.5% after bowel resection and 0% after sacrocolporectopexy. relaparotomy rate was 3.6% and 30-day readmission rate 7.2%. Postoperative hospital stay was median 3 days after small bowel and ileo-colic resection, 4 days after segmental colectomy, and 6 days after rectal resection and subtotal colectomy. Patient's body mass index > 30 kg/m 2 , malignant disease, complexity of surgery, recovery of bowel function later than 2 days after surgery, time to functional recovery > 2 days and postoperative morbidity were patient-and treatment-related determinants increasing postoperative hospital stay. Protocol compliance-related determinants increasing postoperative hospital stay were intake of normal food and mobilization ≥ 6 h/ day later than 2 days after surgery and removal of urinary catheter later than 1 day after surgery.

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Section: Determinants Affecting Postoperative Hospital Staymentioning

confidence: 99%

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

et al. 2014

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“…These studies assessed a broad range of outcomes, including complication rates, duration of surgery, blood loss, length of stay (LOS) in hospital, hospital costs, mortality and disease-specific outcomes. Overall, results are conflicting: some studies are equivocal, 2-4 some show worse outcomes [5][6][7][8][9][10] and others provide evidence of an "obesity paradox," wherein patients who are overweight or mildly obese have better outcomes than those with a healthy weight. [11][12][13][14] Studies assessing obesity and outcomes specifically within general surgery have been similarly inconclusive.…”

Section: Discussionmentioning

confidence: 87%

Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study

Kupper

Karvellas

Khadaroo

et al. 2015

cjs

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41Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study Background: The aim of this study was to assess perioperative outcomes in obese patients undergoing emergency surgery. Methods:We retrospectively reviewed the charts of all adult (> 17 yr) patients admitted to the acute care emergency surgery service at the University of Alberta Hospital between January 2009 and December 2011 who had a body mass index (BMI) of 35 or higher. Patients were divided into subgroups for analysis based on "severe" (BMI 35-39.9) and "morbid" obesity (BMI ≥ 40). Multivariate logistic regression was performed to identify predictors of in-hospital mortality after controlling for confounding factors.Results: Data on 111 patients (55% women, median BMI 39) were included in the final analysis. Intensive care unit (ICU) support was required for 40% of patients. Postoperative complications occurred in 42% of patients, and 31% required reoperation. Overall in-hospital mortality was 17%. Morbidly obese patients had increased rates of reoperation (40% v. 23%, p = 0.05) and increased lengths of stay compared with severely obese patients (14.5 v. 6.0 d, p = 0.09). Age (odds ratio [OR] 1.08 per increment) and preoperative ICU stay (OR 12) were significantly associated with in-hospital mortality after controlling for confounding, but BMI was not. Conclusion:Obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity and mortality. Greater resources are required for their care, including ICU support, repeat surgery and prolonged ICU stay. Future studies could help identify predictors of reoperation and strategies to optimize nutrition, rehabilitation and resource allocation.Contexte : Cette étude avait pour objet d'évaluer les résultats périopératoires chez des patients obèses soumis à une chirurgie d'urgence.

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“…There is also burgeoning evidence that laparoscopic colorectal surgery can be safely completed in the obese with conversion rates varying from 7.3-46%. 8,9 Thus, obesity itself should not be used as a reason not to offer laparoscopic surgery. Nonetheless, within the obese group, there are patients who are undoubtedly more challenging.…”

Section: Discussionmentioning

confidence: 99%

Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

Farid

Mann

et al. 2017

annals

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INTRODUCTION Laparoscopic surgery has become the standard for colorectal cancer resection in the UK but it can be technically challenging in patients who are obese. Patients whose body fat is mainly inside the abdominal cavity are more challenging than those whose fat is mainly outside the abdominal cavity. Abdominal fat ratio (AFR) is a simple parameter proposed by the authors to aid identification of this subgroup. MATERIALS AND METHODS All 195 patients who underwent elective, laparoscopic colorectal cancer resections from March 2010 to November 2013 were included in the study. For patients who were obese (body mass index greater than 30), preoperative staging computed tomography was used to determine AFR. This was assessed by two different, blinded observers and compared with conversion rate. RESULTS Of the 195 patients, 58 (29.7%) fell into the obese group and 137 (70.3%) into the non-obese group. The median AFR of the obese group that were converted to open surgery was significantly higher at 5.9 compared with those completed laparoscopically (3.3, P = 0.0001, Mann-Whitney). There was no significant difference in conversion rate when looking at body mass index, tumour site or size. DISCUSSION Previous studies have found body mass index, age, gender, previous abdominal surgery, site and locally advanced tumours to be associated with an increased risk of conversion. This study adds AFR to the list of risk factors. CONCLUSION AFR is a simple, reproducible parameter which can help to predict conversion risk in obese patients undergoing colorectal cancer resection.

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The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection

Abstract: Laparoscopic colorectal surgery appears to be a safe and reasonable option in obese patients offering the benefits of a minimally invasive approach, with no evidence for compromise in treatment of disease.

Cited by 153 publications

References 46 publications

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study

Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

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