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The Impact of Obesity on Outcomes Following Major Surgery for Crohn's Disease: An American College of Surgeons National Surgical Quality Improvement Program Assessment

Causey, Marlin W. M.D.1; Johnson, Eric K. M.D.2; Miller, Seth M.D.1; Martin, Matthew M.D.1; Maykel, Justin M.D.3; Steele, Scott R. M.D.1

doi: 10.1097/DCR.0b013e3182342ccb
Original Contribution

BACKGROUND: Whereas Crohn's disease is traditionally thought to represent a wasting disease, little is currently known about the incidence and impact of obesity in this patient cohort.

OBJECTIVE: This study aimed to evaluate the perioperative outcomes in patients with Crohn's disease who were obese vs those who were not obese undergoing major abdominal surgery.

DESIGN: This study is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2005–2008). Risk-adjusted 30-day outcomes were assessed by the use of regression modeling accounting for patient characteristics, comorbidities, and surgical procedures.

PATIENTS: Included were all patients with Crohn's disease who were undergoing abdominal operations.

MAIN OUTCOME MEASURE: The primary outcomes measured were short-term perioperative outcomes. Obesity was defined as a BMI of 30 or greater.

RESULTS: We identified 2319 patients (mean age, 41.6 y; 55% female). Of these patients, 379 (16%) met obesity criteria, 2% were morbidly obese, and 0.3% were super obese. Rates of obesity significantly increased each year over the study period. Twenty-five percent of the surgeries were performed laparoscopically (obese 21% vs nonobese 26%). Six percent were emergent, with no difference in patients with obesity. Operative times were significantly longer among patients with obesity (177 min) compared with patients who were not obese (164 min). After adjusting for differences in comorbidities and steroid use, overall perioperative morbidity was significantly higher in the obese cohort (32% vs 22% nonobese; OR 1.9). In addition, the rates of postoperative complications increased directly with rising BMI. Irrespective of procedure type, the patients who were obese were significantly more likely to experience wound infections (OR 1.7), which increased even further in patients who were morbidly obese (BMI >40; OR 7.1). By specific operation, postoperative morbidity was increased in patients with obesity following colectomies with primary anastomosis for both open and laparoscopic approaches (OR 2.9 and OR 3.8). Cardiac, pulmonary, and renal complications as well as overall mortality did not differ significantly based on BMI.

LIMITATIONS: This study was limited by being a retrospective review, and by using data limited to the American College of Surgeons National Surgical Quality Improvement Program database.

CONCLUSION: Increasing BMI adversely affects perioperative morbidity in patients with Crohn's disease.

1 Department of Surgery, Madigan Army Medical Center, Ft. Lewis, Washington

2 Department of Surgery, Eisenhower Army Medical Center, Ft. Gordon, Georgia

3 Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts

Disclaimer: The American College of Surgeons National Quality Improvement Project (ACS-NSQIP) and the hospitals participating in the ACS-NSQIP are the source of the data used here; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

The investigators have adhered to the policies for protection of human subjects as prescribed in 45 CFR part 46.

The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the US Government.

Financial Disclosures: None reported.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Vancouver, BC, Canada, May 14 to 17, 2011.

Correspondence: Scott R. Steele, M.D., 9606 Piperhill Dr SE, Olympia, WA 98513. E-mail: harkersteele@mac.com

© The ASCRS 2011