Body mass index predicts operative time in elective colorectal procedures

Saiganesh, Harish; Stein, David E.; Poggio, Juan Lucas

doi:10.1016/j.jss.2015.02.067

Cited by 17 publications

(10 citation statements)

References 16 publications

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“…13 Therefore, it is not surprising that increased BMI was also associated with more wound complications as prolonged operative time has been shown to be a predictor of postoperative wound infections. [14][15][16][17] Overall morbidity and postsurgical complications were highest in the morbidly obese patients, which is consistent with some published literature, 13 however, there are other retrospective studies that dispute this finding. 18 Conversely, we found that rates of DVT were lower in the morbidly obese group.…”

Section: Discussionsupporting

confidence: 87%

Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

Alizadeh

Moghadamyeghaneh

Whealon

et al. 2016

The American Surgeon

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There are limited data regarding the association between body mass index (BMI) and colorectal surgery outcomes. We sought to evaluate the effect of BMI on short-term surgical outcomes in colon and rectal surgery patients in the United States. The American College of Surgeons National Surgery Quality Improvement Project database was used to identify all patients who underwent colon or rectal resection from 2005 to 2013. Multivariate regression analysis was used to assess the independent effect of BMI on outcomes. A total of 206,360 patients underwent colorectal resection during the study period. Of these, 3.2 per cent of patients were underweight (BMI < 18.5), 23.8 per cent patients were normal weight (18.5 ≤, BMI < 25), 26.5 per cent were overweight (25 ≤, BMI < 30), 25.2 per cent were obese (30 ≤, BMI < 40), and 5.3 per cent were morbidly obese (BMI ≥ 40). Underweight patients had longer length of stay (confidence interval: 2.70–3.49, P < 0.001) and higher mortality (adjusted odds ratio: 1.45, P < 0.01) compared with patients with a normal BMI. Morbidly obese patients had the highest overall morbidity rate compared with normal BMI patients (adjusted odds ratio: 1.53, confidence interval: 1.42–1.64, P < 0.01). BMI is associated with outcomes in colon and rectal surgery patients. Underweight and morbidly obese patients have a significantly increased risk of postsurgical complications compared with those with normal BMI.

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Section: Discussionsupporting

confidence: 87%

Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

Alizadeh

Moghadamyeghaneh

Whealon

et al. 2016

The American Surgeon

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“…Although the actual correlation was weak ( ρ = 0.182), it was statistically significant and linear regression analysis showed that for every increase in one unit of BMI operative time increased by roughly 2 min. We are not the first study to demonstrate that BMI is an independent predicting factor for operative time, with three previously published studies demonstrating similar results [22–24], one of which compared the operative times of morbidly obese (BMI ≥ 35) patients to non-obese patients [22]. …”

Section: Discussionmentioning

confidence: 82%

Minimally invasive colorectal surgery in the morbid obese: does size really matter?

et al. 2018

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BackgroundAs obesity becomes more prevalent, it presents a technical challenge for minimally invasive colorectal resection surgery. Various studies have examined the clinical outcomes of obese surgical patients. However, morbidly obese patients (BMI ≥ 35) are becoming increasingly more common. This study aims to investigate the short-term surgical outcomes of morbidly obese patients undergoing minimal-invasive colorectal surgery and compare them with both obese (30 ≤ BMI < 35) and non-obese patients (BMI < 30).MethodsPatients from three centres who received minimally invasive colorectal surgical resections between 2006 and 2016 were identified from prospectively collected databases. The baseline characteristics and surgical outcomes of morbidly obese, obese and non-obese patients were analysed.ResultsA total of 1386 patients were identified, 84 (6%) morbidly obese, 246 (18%) obese and 1056 (76%) non-obese. Patients’ baseline characteristics were similar for age, operating surgeon, surgical approach but differed in terms of ASA grade and gender. There was no difference in conversion rate, length of stay, anastomotic leak rate and 30-day readmission, reoperation and mortality rates. Operation time and blood loss were different across the 3 groups (morbidly obese vs obese vs non-obese: 185 vs 188 vs 170 min, p = 0.000; 20 vs 20 vs 10 ml, p = 0.003). In patients with malignant disease there was no difference in lymph node yield or R0 clearance. Univariate and multivariate linear regression analysis showed that for every one-unit increase in BMI operative time increases by roughly 2 min (univariate 2.243, 95% CI 1.524–2.962; multivariate 2.295; 95% CI 1.554–3.036). Univariate and multivariate binary logistic regression analyses showed that BMI does not affect conversion or morbidity and mortality.ConclusionsThe increased technical difficulty encountered in obese and morbidly obese patients in minimally invasive colorectal surgery results in higher operative times and blood loss, although this is not clinically significant. However, conversion rate and post-operative short-term outcomes are similar between morbidly obese, obese and non-obese patients.

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“…Specifically there are studies evaluating operative time and outcome for the same stage of cancer and the specific segment of colon [24]. In particular the tumors of the transverse colon have been thoroughly studied, as representing a more challenging site with complex decision making management [25]. A certain number of studies also addressed the effectiveness of the application of the laparoscopic approach to diverticular disease and inflammatory bowel diseases compare to open, concluding that the laparoscopy takes longer [26].…”

Section: Open Access Journal Of Surgery Discussionmentioning

confidence: 99%

Laparoscopic Versus Open Colectomies: Enhanced Surgical Skills And Rigorous Patient Selection May Improve Operative Times Without Compromising Outcomes

Stergios¹

2017

OAJS

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The aim of our study was to compare the demographic characteristics, the intra-and postoperative outcomes of patients undergoing laparoscopic and open colorectal resections with or without stoma and with or without anastomosis.Method: Our study includes 133 patients, who underwent laparoscopic and open colorectal resections for colonic and rectal disease.Results: There was a statistically significant decrease of the operative duration time for the laparoscopic group [(182 min (103-341 min)] compared to the laparotomy group [(242 min (71-584 min)] (p=.006). The other parameters, such us age, BMI, blood loss, transfusion, leak, reoperation, 60-day mortality, wound infection, wound dehiscence, atelectasis, sepsis, ileus, UTI, first flatus and length of stay presented no difference. Conclusion:The experience accumulated by the Colorectal surgeons and the careful selection of the patients seem to improve the operative duration and thus they provide both the surgeon and the patient with all the advantages of a short operation. On the other hand, the two techniques have no differences and the choice is made each time by the surgeon according to the indications and the patient status.

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Body mass index predicts operative time in elective colorectal procedures

Cited by 17 publications

References 16 publications

Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

Minimally invasive colorectal surgery in the morbid obese: does size really matter?

Laparoscopic Versus Open Colectomies: Enhanced Surgical Skills And Rigorous Patient Selection May Improve Operative Times Without Compromising Outcomes

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