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

Abstract

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.

Association between body mass index and in-hospital outcomes

“…While obesity involves excess caloric intake, several studies have shown a high prevalence of micronutrient deficiencies in obese patients across a broad range of both vitamins and minerals. [ 58 ] Alternatively, it is possible that BMI is a poor measure of body fat due to the positive correlation between BMI and muscle mass, while lean muscle mass has been shown to exert protective effects on cardiometabolic diseases such as CVD and cancer. Studies among COPD [ 59 ] and cancer [ 60 ] patients have demonstrated that overweight or obese patients are at increased risk for malnutrition, which contributes to poor outcomes.…”

Case Report: Are We Prepared to Manage Acute Abdomen in the Super-Obese Patient?

“…They showed high perioperative morbidity. These results were worse in patients with higher BMIs [15].…”

Obesidad Como Factor Asociado a Complicaciones Posperatorias en Pacientes Sometidos a Cirugía Abdominal en El Centro Médico Naval “Cirujano Mayor Santiago Tavara” Durante El 2015.

“…En contraste con el estudio realizado en el Servicio de Cirugía en un Hospital de Canadá, donde se demuestra que en situaciones de intervenciones de emergencia los pacientes obesos tienen un mayor riesgo de complicaciones postoperatorias 7 .…”