Influence of Body Mass Index on Outcomes in Patients Undergoing Surgery for Diverticular Disease
18 Pages Posted: 29 Apr 2019 First Look: Under Review
Background: We hypothesized that increasing BMI is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of BMI and surgical complications following surgery for diverticular disease.
Methods: We used NSQIP database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their BMI (<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 (SSI), deep incisional SSI, organ space SSI, wound disruption complications, pneumonia, ventilator dependence >48 hours, acute renal failure, MI, return to OR, and 30 day mortality.
Results: Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher ASA classification and were more likely to have emergency and open cases. Interestingly, increased BMI was inversely associated with age. Increasing BMI was associated with worse outcomes including superficial SSI, deep incisional SSI, organ space SSI, wound disruption complications, ventilator dependence >48hrs, acute renal failure, and return to OR. Risk of developing pneumonia didn't have similar correlation with BMI. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of MIwere noted. Underweight patients also developed worse outcomes.
Conclusion: Obesity is associated with a number of complications following surgery for diverticulitis.Elevated BMI 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 surgery for diverticular disease.
Keywords: diverticulitis, obesity, complications, surgery, BMI, outcomes
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