Obesity and Laparoscopic Colectomy

Mustain, W. Conan; Davenport, Daniel L.; Hourigan, Jon S.; Vargas, H. David

doi:10.1097/dcr.0b013e31823dfb17

Cited by 76 publications

(20 citation statements)

References 25 publications

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“…When looking solely at BMI categories to define obesity, a large retrospective surgical registry demonstrated a 10% higher rate of post-operative morbidity among obese Crohn’s patients, driven by a nearly two-fold higher rate of post-operative infection (nearly seven-fold higher in individuals whose BMI was greater than 40 kg/m 2 )[ 107 ]. This same registry also demonstrated similar findings for obese individuals-not specific to the IBD population-undergoing laparoscopic colectomy[ 108 ]. Two smaller single-center retrospective series did not demonstrate a higher risk of peri-operative morbidity among obese Crohn’s patients when stratified by BMI criteria[ 109 , 110 ].…”

Section: Obesity and Ibd-related Surgerymentioning

confidence: 59%

Interaction of obesity and inflammatory bowel disease

Harper

Zisman

2016

WJG

126

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Inflammatory bowel disease (IBD) is a chronic inflammatory condition of unknown etiology that is thought to result from a combination of genetic, immunologic and environmental factors. The incidence of IBD has been increasing in recent decades, especially in developing and developed nations, and this is hypothesized to be in part related to the change in dietary and lifestyle factors associated with modernization. The prevalence of obesity has risen in parallel with the rise in IBD, suggesting a possible shared environmental link between these two conditions. Studies have shown that obesity impacts disease development and response to therapy in patients with IBD and other autoimmune conditions. The observation that adipose tissue produces pro-inflammatory adipokines provides a potential mechanism for the observed epidemiologic links between obesity and IBD, and this has developed into an active area of investigative inquiry. Additionally, emerging evidence highlights a role for the intestinal microbiota in the development of both obesity and IBD, representing another potential mechanistic connection between the two conditions. In this review we discuss the epidemiology of obesity and IBD, possible pathophysiologic links, and the clinical impact of obesity on IBD disease course and implications for management.

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Section: Obesity and Ibd-related Surgerymentioning

confidence: 59%

Interaction of obesity and inflammatory bowel disease

Harper

Zisman

2016

WJG

126

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“…7 Other patient-related and procedure-oriented risk factors such as open surgery, emergency operations, obesity, American Society of Anesthesiologists class, and bleeding disorders have been associated with VTE in some series 5,14,16,29–31 but not in others. 32,33 Furthermore, recent data suggest that patients with inflammatory bowel disease may represent an underrecognized group associated with particularly high risk of VTE complications. 6,7 …”

Section: Discussionmentioning

confidence: 99%

Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery

et al. 2015

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IMPORTANCE Venous thromboembolism (VTE) is an important complication of colorectal surgery, but its incidence is unclear in the era of VTE prophylaxis. OBJECTIVE To describe the incidence of and risk factors associated with thromboembolic complications and contemporary VTE prophylaxis patterns following colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database. At 52 Washington State SCOAP hospitals, participants included consecutive patients undergoing colorectal surgery between January 1, 2006, and December 31, 2011. MAIN OUTCOMES AND MEASURES Venous thromboembolism complications in-hospital and up to 90 days after surgery. RESULTS Among 16 120 patients (mean age, 61.4 years; 54.5% female), the use of perioperative and in-hospital VTE chemoprophylaxis increased significantly from 31.6% to 86.4% and from 59.6% to 91.4%, respectively, by 2011 (P < .001 for trend for both). Overall, 10.6% (1399 of 13 230) were discharged on a chemoprophylaxis regimen. The incidence of VTE was 2.2% (360 of 16 120). Patients undergoing abdominal operations had higher rates of 90-day VTE compared with patients having pelvic operations (2.5% [246 of 9702] vs 1.8% [114 of 6413], P = .001). Those having an operation for cancer had a similar incidence of 90-day VTE compared with those having an operation for nonmalignant processes (2.1% [128 of 6213] vs 2.3% [232 of 9902], P = .24). On adjusted analysis, older age, nonelective surgery, history of VTE, and operations for inflammatory disease were associated with increased risk of 90-day VTE (P < .05 for all). There was no significant decrease in VTE over time. CONCLUSIONS AND RELEVANCE Venous thromboembolism rates are low and largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines.

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“…Patients with a diagnosis of inflammatory bowel disease, end-stage renal disease, and disseminated cancer were excluded to avoid potential bias associated with unusually high complication rates in these populations. 10,11 Patients were stratified by BMI and divided into five groups: underweight (18.5 > BMI), normal BMI (18.5 # BMI < 25), overweight (25 # BMI < 30), obese (30 $ BMI > 40), and morbidly obese (BMI $ 40) in line with the BMI classification proposed by the NIH.12 Variables used in the analysis were provided by the NSQIP database and included patient demographics (age, sex, and race), American Society of Anesthesiologists (ASA) score, as well as patient comorbidities [congestive heart failure (CHF), moderate or severe dyspnea, ascites, diabetes mellitus requiring medication, chronic steroid use, history of severe chronic obstructive pulmonary disease (COPD), weight loss more than 10% in last six months, alcohol abuse, smoking status, history of myocardial infarction (MI), preoperative angina, preoperative pneumonia, preoperative acute renal failure, and hypertension requiring medication].…”

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confidence: 99%

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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Obesity and Laparoscopic Colectomy

Cited by 76 publications

References 25 publications

Interaction of obesity and inflammatory bowel disease

Interaction of obesity and inflammatory bowel disease

Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery

Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

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