Influence of body mass index on outcomes in patients undergoing surgery for diverticular disease

Abstract

Background We hypothesized that increasing body mass index is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of body mass index and surgical complications following surgery for diverticular disease. Methods We used National Surgical Quality Improvement Program database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their body mass index (< 18.5, 18.6–24.9, 25.0–29.9, 30.0–34.9, 35.0–39.9, 40.0–44.9, 45.0–49.9, 50.0–54.9, > 55). Outcomes of interest were complications of superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, pneumonia, ventilator dependence > 48 hours, acute renal failure, myocardial infarction, return to operating room, and 30-day mortality. Results Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher American Society of Anesthesiologists classification and were more likely to have emergency and open cases. Interestingly, increased body mass index was inversely associated with age. Increasing body mass index was associated with worse outcomes including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to operating room. Risk of developing pneumonia didn't have similar correlation with body mass index. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of myocardial infarction were noted. Underweight patients also developed worse outcomes. Conclusion Obesity is associated with a number of complications following surgery for diverticulitis. Elevated body mass index adds significant risk to procedures for diverticulitis and should be accounted for in risk stratification models. Patients should be counseled on weight reduction before undergoing elective surgery for diverticular disease.

Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis

“…Despite this notable increase in MO prevalence and the probable increase in the severity and complications of CDD, we noted a decline in mortality and LOS over the study period. These improvements in overall outcomes are contrary to the findings of other retrospective reviews [30,31] that showed that patients with higher visceral/subcutaneous fat ratios and increasing body mass index were more likely to require emergency surgery, have longer hospital stays, and develop more complications, including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to the operating room. Neither study, however, demonstrated worse mortality outcomes.…”

Exploration of wound‐related complications post‐kidney transplantation

“…31 Additional research employing more substantial sample sizes may yield advantageous results in definitively ascertaining the influence of body mass index (BMI) on complications associated with wounds following transplantation. [32][33][34] In contrast to findings that have suggested genderspecific variations in surgical outcomes, the incidence of wound complications was not substantially impacted by the gender of the recipients. 35 Variations in surgical techniques, demographic distinctions, or holistic care approaches utilized by the participating centres could account for this disparity.…”

“…Based on our analysis, it appears that an elevated body mass index (BMI) might be correlated with an increased likelihood of postoperative complications; however, this finding did not attain the usual thresholds of statistical significance 31 . Additional research employing more substantial sample sizes may yield advantageous results in definitively ascertaining the influence of body mass index (BMI) on complications associated with wounds following transplantation 32–34 …”

“… 31 Additional research employing more substantial sample sizes may yield advantageous results in definitively ascertaining the influence of body mass index (BMI) on complications associated with wounds following transplantation. 32 , 33 , 34 …”