The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

Abstract

Background Obesity has been shown to increase the rates of morbidity and occasionally mortality in patients undergoing nonbariatric elective surgery. However, little is known about the impact of obesity on outcomes after surgery for high-risk abdominal emergencies. Methods A single-center retrospective evaluation of outcomes in high-risk abdominal emergency patients categorized by body mass index (BMI) was conducted. Patient demographics, comorbidities, and operative details were analyzed. Patients with normal weight (BMI 18.5–24.9) served as comparators. Multivariable linear and logistic regression analyses were performed to assess the impact of obesity on surgical outcomes. Results In total, 886 patients with BMI < 18.5 (underweight; n = 50), 18.5–24.9 (normal weight; n = 306), 25–29.9 (overweight; n = 336) and ≥ 30 (obese; n = 194) based on the World Health Organization (WHO) weight classification criteria met the inclusion criteria. Compared to normal-weight patients, patients with overweight and obesity were older and more likely to be male. The rates of comorbidity (100% vs 91.2%, p = < 0.0001), morbidity (77.8% vs 65.6%, p = 0.003), and in-hospital mortality (44.8% vs 30.4%, p = 0.001) were all higher in patients with obesity than in normal-weight patients. Patients with obesity had an increased intensive care unit length of stay (ICU LOS) (13 days vs 9 days, p = 0.019) and hospital LOS (21.4 days vs 18.1 days, p = 0.081) and prolonged ventilation (39.1% vs 19.6%, p = 0.003). As BMI deviated from the normal range, the morbidity and mortality rates increased incrementally, with the highest morbidity (87.9%) and mortality (54.5%) rates observed in morbidly obese patients (BMI ≥ 40). Conclusions Patients with obesity were the most likely to have coexisting conditions, experience postoperative complications, and die during the first admission following EL for high-risk abdominal emergencies.

Quantification of surgical workflow during robotic proctectomy

“…For instance, some of our patients did not require anastomosis, while others required both anastomosis and diverting ileostomy. Additionally, patient‐related factors such as obesity, adhesions, history of radiation, or more advanced pathology, can influence CT and TOT 21,22 . For these reasons, as well as others, we are exploring more precise and comprehensive ways of understanding surgical workflow and its effects on CT and TOT.…”

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

“…Several studies have examined the independent impact of obesity on surgical mortality after noncardiac surgery. Yet, most have failed to show that obesity is associated with increased morbidity after noncardiac surgery ( 48 , 49 ). The largest study to date, by Mullen et al, also based on the ACS NSQIP database, showed a mild protective effect of BMI on mortality for overweight and obese patients undergoing general surgery ( 50 ).…”

Association of body mass index with post‐liver transplant outcomes

“…This study evaluated LT recipients from the multicenter Functional Assessment in Liver Transplantation (FrAILT) study, a prospective cohort study that includes eight LT centers in the U.S. (University of California San Francisco, Baylor, Columbia, Duke, Johns Hopkins, Loma Linda, Northwestern, and University of Pittsburgh) and evaluates the relationship between pre‐LT physical frailty and liver waitlist and post‐LT outcomes. Briefly, patients were eligible to enroll in the FrAILT Study if they 1 had cirrhosis and were approved for listing for LT at participating sites, 2 were evaluated in the ambulatory setting, and 3 had a Model for End‐Stage Liver Disease (MELD) score ≥12 at the time of enrollment. Excluded were those with severe cognitive dysfunction at the time of study screening (given concerns about ability to provide signed informed consent) and those who did not speak English, Spanish, or Chinese (given availability of written consent forms in other languages) 19 .…”

“…Obesity has been associated with higher risk of prolonged intubation, postoperative complications, and reoperation; longer intensive care unit (ICU) and hospital lengths of stay (LOS); and higher risk of non-home discharge location in various surgical populations. [1][2][3][4][5] However, despite the rising proportion of LT candidates and recipients with obesity, there are mixed findings about the relationship between obesity and post-transplant complications. Careful assessment of the association between obesity and post-LT outcomes is critical, given that several American and European guidelines suggest a BMI≥40 as a relative contraindication for LT, [6][7][8] a recommendation that is followed by over half of all U.S. LT centers.…”

“…The national obesity epidemic has resulted in higher body mass indices (BMIs) for surgical patients, including liver transplant (LT) recipients. Obesity has been associated with higher risk of prolonged intubation, postoperative complications, and reoperation; longer intensive care unit (ICU) and hospital lengths of stay (LOS); and higher risk of non‐home discharge location in various surgical populations 1–5 . However, despite the rising proportion of LT candidates and recipients with obesity, there are mixed findings about the relationship between obesity and post‐transplant complications.…”