Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery

Abstract

BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

“…The research collaborative model has been described previously, successfully delivering a number of national cohort studies8 9.…”

“…Given the imprecision of measurement of eGFR above 120 ml per min per 1·73 m 2 , eGFR values were bounded at this level. Surgical procedures were classified as low, medium or high risk according to 30‐day mortality rates reported in Hospital Episode Statistics9. Patients were split into planned open and planned laparoscopic surgery groups.…”

A third of patients treated at a tertiary-level surgical service could be treated at a secondary-level facility

“…[9,11] Productive, relevant research is possible when clinicians engage with and support students toward a defined research goal.…”

“…[8] Medical students represent a skilled group, who are willing and keen to participate, and student-aided research in surgery has resulted in several recent publications in prominent journals. [5,9] CMJAH has four general surgical wards, with a total of 92 beds. The four wards are divided into breast and endocrine, gastroenterology, vascular, and trauma.…”

Students are underused and undervalued in quality improvement

“…Recommendations from the first meeting were submitted to the Francis report and informed the Royal College of Nursing’s response to the Shape of Caring consultation 34. Similarly, STARSurg is a student driven national collaboration that has enabled students to participate in high quality national audits567 and empowered them to improve patient care. Such examples of student mobilisation in quality improvement are rare.…”