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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000097
Original Contributions: Colorectal/Anal Neoplasia

Impact of BMI on Postoperative Outcomes in Patients Undergoing Proctectomy for Rectal Cancer: A National Surgical Quality Improvement Program Analysis

Smith, Radhika K. M.D.1; Broach, Robyn B. Ph.D.2; Hedrick, Traci L. M.D.3; Mahmoud, Najjia N. M.D.4; Paulson, E. Carter M.D., M.S.C.E.4

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Abstract

BACKGROUND: There is a mounting body of evidence that suggests worsened postoperative outcomes at the extremes of BMI, yet few studies investigate this relationship in patients undergoing proctectomy for rectal cancer.

OBJECTIVE: We aimed to examine the relationship between BMI and short-term outcomes after proctectomy for cancer.

DESIGN: This was a retrospective study comparing the outcomes of patients undergoing proctectomy for rectal cancer as they relate to BMI.

SETTINGS: The American College of Surgeons-National Surgical Quality Improvement Program database was queried for this study.

PATIENTS: Patients included were those who underwent proctectomy for rectal neoplasm between 2005 and 2011.

MAIN OUTCOME MEASURES: Study end points included 30-day mortality and overall morbidity, including the receipt of blood transfusion, venous thromboembolic disease, wound dehiscence, renal failure, reintubation, cardiac complications, readmission, reoperation, and infectious complications (surgical site infection, intra-abdominal abscess, pneumonia, and urinary tract infection). Univariate logistic regression was used to analyze differences among patients of varying BMI ranges (kg/m2; ≤20, 20-24, 25-29, 30-34, and ≥35). When significant differences were found, multivariable logistic regression, adjusting for preoperative demographic and clinical variables, was performed.

RESULTS: A total of 11,995 patients were analyzed in this study. The incidences of overall morbidity, wound infection, urinary tract infection, venous thromboembolic event, and sepsis were highest in those patients with a BMI of ≥35 kg/m2 (OR, 1.63, 3.42, 1.47, 1.64, and 1.50). Wound dehiscence was also significantly more common in heavier patients. Patients with a BMI <20 kg/m2 had significantly increased rates of mortality (OR, 1.72) and sepsis (OR, 1.30).

LIMITATIONS: This study was limited by its retrospective design. Furthermore, it only includes patients from the American College of Surgeons-National Surgical Quality Improvement Program database, limiting its generalizability to nonparticipating hospitals.

CONCLUSIONS: Obese and underweight patients undergoing proctectomy for neoplasm are at a higher risk for postoperative complications and death.

© 2014 The American Society of Colon and Rectal Surgeons

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