Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database

Abstract

Objective To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design Retrospective cohort study. Setting Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P < .001), rate of diabetes (18.2% vs 7.2%, P < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, P < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P = .02) and have disseminated cancer (<1% vs 3.2%, P < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P = .022). There was no statistical difference in medical complications ( P = .775), unplanned readmissions ( P = .286), unplanned reoperations ( P = .053), or 30-day mortality ( P > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.

Factors Associated With Unanticipated Admission After Outpatient Endoscopic Sinonasal Surgery

“…20,21 Wardlow et al utilized the NSQIP database to examine the implications of obesity on postoperative adverse events (e.g., unplanned admission, unplanned reoperation, bleeding) of ESS. 11 Interestingly, they found that elevated body mass index (≥30) was a significant predictor of reduced surgical complications after adjusting for other demographic factors and comorbidities (OR: 0.740; 95% CI, 0.566-0.968, P = .028). They hypothesized that overweight and mildly obese patients have higher metabolic states and nutritional reserves that allow them to withstand inflammatory stressors such as surgical intervention.…”

“…9,10 Although acute complications are typically rare, with frequencies ranging from 0% to 3% in prior studies, their incidence may be greater in patients with certain predispositions, such as obesity, uncontrolled hypertension, and poorly controlled asthma. 5,11 Surgeons would benefit from a better understanding of preoperative risk factors, as this would aid in reducing the incidence of admission after planned outpatient procedures. 12 Our study utilized the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP), a large national database that collects prospective patient information from a wide assortment of surgical cases.…”

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

“…Postoperative complications were categorized as surgical or medical complications, consistent with previous NSQIP studies in the literature. 20,21 Surgical complications consisted of superficial surgical site infection (SSI), deep SSI, organ/space SSI, wound disruption, and blood transfusion within 72 hours. Medical complications consisted of pneumonia, unplanned reintubation, urinary tract infection, deep vein thrombosis, renal insufficiency, pulmonary embolism, ventilator >48 hours, acute renal failure, cerebrovascular accident with neurological deficit, cardiac arrest requiring cardiopulmonary resuscitation, myocardial infarction, sepsis, or septic shock.…”

The association of frailty, age, and ASA classification with postoperative outcomes in minimally invasive pituitary surgery

“…Complications were categorized as surgical or medical according to previous NSQIP studies. 3 ASA classification was categorized as 1-2, 3, and 4-5. Patients were also divided into three groups according to age (18-49, 50-64, ≥65 years).…”

“…Patients were divided into three mFI groups (0, 1, 2–5). Complications were categorized as surgical or medical according to previous NSQIP studies 3 . ASA classification was categorized as 1–2, 3, and 4–5.…”