The obesity paradox in the surgical population

Valentijn, Tabita M.; Galal, Wael; Tjeertes, Elke K.M.; Hoeks, Sanne E.; Verhagen, Hence J.M.; Stolker, Robert Jan

doi:10.1016/j.surge.2013.02.003

Cited by 136 publications

(133 citation statements)

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“…Excess body weight/mass has been explored as a predictor of postoperative outcomes after a variety of surgical procedures. A recent review of the link between excess BMI and outcomes after nonbariatric general surgery identified mixed results, with increased morbidity and mortality associated with extreme obesity, whereas being overweight or moderately obese did not confer an increase in perioperative risk [14]. Similar mixed findings have been reported for outcomes from cardiovascular surgery.…”

Section: Discussionmentioning

confidence: 69%

“…Adipose tissue, particularly nonvisceral adipocytes, secretes cytokines that regulate inflammation, endovascular homeostasis and insulin sensitivity. Adipose tissue is capable of scavenging inflammatory toxins, and lipoproteins that are often increased in the obese can bind to and neutralize endotoxins [14,21]. In contrast, low BMI may not be a specific cause of increased risk, but instead may be a result of other acute or chronic processes that themselves increase risk such as smoking and chronic obstructive pulmonary disease (COPD).…”

Section: Discussionmentioning

confidence: 99%

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Association of body mass index and outcomes after major lung resection

Ferguson

Watson

et al. 2014

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Obesity has been thought to predispose patients to excess morbidity after lung resection because of decreased diaphragm excursion, reduced lung volumes and relative immobility. We assessed the relationship of body mass index (BMI) to acute outcomes after major lung resection. METHODS:Information from our database of lung resections was evaluated for the period 1980-2011. Univariate analysis for adverse events ( pulmonary, cardiovascular, other and overall) was used to select variables for inclusion in multivariate logistic regression analyses. Missing values were imputed. BMI was categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and very obese (≥35).RESULTS: Among 1369 patients, there were 703 males (51%) and the mean age was 62 ± 11 years. Complications included the following: pulmonary 12%, cardiovascular 15%, other 16%, mortality 5% and any 29%. The incidence of complications decreased during each decade of study (40, 30, 26, 20%; P < 0.0001) and the incidence of obese/very obese increased during the same intervals (11, 22, 30, 25%; P = 0.0007). Adjusting for age, performance status, coronary artery disease, smoking status, diffusing capacity of the lung for carbon monoxide, forced expiratory volume in 1 s and operation year, being overweight/obese/very obese did not increase the risk of postoperative complications in any category. In fact, patients in this group showed a lower rate of cardiovascular complications than those with BMI ≤ 25 (odds ratio (OR): 0.72; 95% confidence interval (CI): 0.51-1.00; P = 0.048). However, being underweight was importantly associated with an increased risk of pulmonary complications (OR: 2.5; 95% CI: 1.3-4.9; P = 0.0087) and of operative mortality (OR: 2.96; 95% CI: 1.28-6.86; P = 0.011). CONCLUSION:Being overweight or obese does not increase the risk of complications after major lung resection. In contrast, patients who are underweight are at significantly increased risk of pulmonary complications and mortality. Knowledge of the relationship of BMI to perioperative risk for major lung resection is essential in proper risk stratification.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Association of body mass index and outcomes after major lung resection

Ferguson

Watson

et al. 2014

European Journal of Cardio-Thoracic Surgery

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“…Tokunaga et al [22] supported the existence of an obesity paradox in patients who underwent curative gastrectomy for gastric cancer, describing a better 5-year OS rate for overweight compared to non-overweight Japanese patients. Valentijn et al [23] reviewed existing literature on the obesity paradox in the surgical population and showed worst mortality rates for underweight and morbidly obese patients. They concluded that the etiology of the obesity paradox may be multi-factorial and analyzed possible reasons.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

et al. 2016

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Background: Obesity is generally considered to be associated with increased postoperative morbidity and mortality following intraabdominal cancer surgery. However, recent reports showed that overweight patients may have a lower risk for adverse postoperative outcomes and this observation has been described as the ‘obesity paradox'. Therefore, we aimed to analyze the impact of obesity on outcomes after resection for gastric cancer. Methods: Data of patients who underwent resection for gastric cancer between 2005 and 2012 were assessed. Patient characteristics, postoperative outcomes and long-term survivals were compared between patients with body mass index (BMI) ≥30 and <30. Results: Resection for gastric cancer was performed in 249 patients. BMI ≥30 was identified in 49 patients. Obese patients with BMI ≥30 were more frequently diagnosed with diabetes (31 vs. 16%, p = 0.015). Resection for gastric cancer in obese patients was significantly associated with longer duration of surgery (278 vs. 243 min, p < 0.001), longer duration of hospital stay (18 vs. 16 days, p = 0.028), increased postoperative morbidity (49 vs. 33%, p = 0.037), and increased postoperative mortality (10 vs. 3%, p = 0.028). There was no significant difference in overall survival (OS) between patients with BMI ≥30 and patients with BMI <30 (5-year OS rate: 59 vs. 62%, p = 0.587). Conclusion: Obesity may complicate resection for gastric cancer increasing the duration of surgical procedure, hospital stay and postoperative morbidity and mortality. However, BMI did not predict OS in our patients. Consequently, BMI may be too simple as a parameter to evaluate sophisticated interactions between different body fat compartments and inflammatory and immune responses and thus to predict long-term oncologic outcomes.

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“…Older age and lower preoperative Hct increase the likelihood of intraoperative RBC transfusion. On the other hand, overweight and obese patients have a decreased risk for intraoperative blood transfusion (27)(28) . Therefore, in our sample, a lower weight might have contributed to increased risk of intraoperative and postoperative RBC blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

Lopes

Brunori

Cavalcante

et al. 2015

Rev. esc. enferm. USP

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Objective: To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. Method: A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. Results: The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3 /mm 3 , lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. Conclusion: Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

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The obesity paradox in the surgical population

Cited by 136 publications

References 100 publications

Association of body mass index and outcomes after major lung resection

Association of body mass index and outcomes after major lung resection

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

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