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Sood, A; Abdollah, F; Sammon, JD; Majumder, K; Schmid, M; Peabody, JO; Preston, MA; Kibel, AS; Menon, M; Trinh, QD.
The Effect of Body Mass Index on Perioperative Outcomes After Major Surgery: Results from the National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2011.
World J Surg. 2015; 39(10):2376-85 Doi: 10.1007/s00268-015-3112-7
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Co-authors Med Uni Graz: Leitsmann Marianne
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Abstract:: BACKGROUND: Obesity is associated with poor surgical outcomes and disparity in access-to-care. There is a lack of quality data on the effect of body mass index (BMI) on perioperative outcomes. Accordingly, we sought to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing major surgery. METHODS: Participants included individuals undergoing one of 16 major surgery (cardiovascular, orthopedic, oncologic; n = 141,802) recorded in the ACS-NSQIP (2005-2011). Outcomes evaluated included complications, blood transfusion, length-of-stay (LOS), re-intervention, readmission, and perioperative mortality. Multivariable-regression models assessed the independent-effect of BMI on outcomes. RESULTS: Nearly, 74 % of patients had a BMI disturbance; the majority being overweight (35.3 %) or obese (29.8 %). Morbidly obese patients constituted a small but significant proportion of the patients (5.7 %; n = 8067). In adjusted-analyses, morbidly obese patients had significantly increased odds of wound complications in 15 of the examined procedures, of renal complications after 6-procedures, of thromboembolism after 5-procedures, of pulmonary, septic and UTI complications after 2-procedures, and of cardiovascular complications after CABG. Conversely, obese/overweight patients, except for increased odds of wound complications after select procedures, had significantly decreased odds of perioperative mortality, prolonged-LOS and blood transfusion relative to normal BMI patients after 4, 8, and 9 of the examined procedures. CONCLUSIONS: The prevalence of BMI derangements in surgical patients is high. The effect of BMI on outcomes is procedure specific. Patients with BMI between 18.5 and 40-kg/m(2) at time of surgery fare equally well with regard to complications and mortality. However, morbidly obese patients are at-risk for postsurgical complications and targeted preoperative-optimization may improve outcomes and attenuate disparity in access-to-care.
Find related publications in this database (using NLM MeSH Indexing): Adult - administration & dosage; Aged - administration & dosage; Aged, 80 and over - administration & dosage; Blood Transfusion - statistics & numerical data; Body Mass Index - administration & dosage; Female - administration & dosage; Humans - administration & dosage; Length of Stay - statistics & numerical data; Male - administration & dosage; Middle Aged - administration & dosage; Obesity, Morbid - complications, epidemiology; Overweight - complications, epidemiology; Postoperative Complications - epidemiology; Quality Improvement - administration & dosage; Surgical Procedures, Operative - adverse effects; Treatment Outcome - administration & dosage; United States - epidemiology