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Effect of BMI on Outcomes in Proctectomy

Hrabe, Jennifer E. M.D.1; Sherman, Scott K. M.D.1; Charlton, Mary E. Ph.D.2; Cromwell, John W. M.D.1; Byrn, John C. M.D.1

Diseases of the Colon & Rectum: May 2014 - Volume 57 - Issue 5 - p 608–615
doi: 10.1097/DCR.0000000000000051
Original Contributions: Benign Colorectal Disease

BACKGROUND: The unique surgical challenges of proctectomy may be amplified in obese patients. We examined surgical outcomes of a large, diverse sample of obese patients undergoing proctectomy.

OBJECTIVE: The purpose of this work was to determine whether increased BMI is associated with increased complications in proctectomy.

DESIGN: This was a retrospective review.

SETTINGS: The study uses the American College of Surgeons National Surgical Quality Improvement Program database (2010 and 2011).

PATIENTS: Patients included were those undergoing nonemergent proctectomy, excluding rectal prolapse cases. Patients were grouped by BMI using the World Health Organization classifications of underweight (BMI <18.5); normal (18.5-24.9); overweight (25.0-29.9); and class I (30.0-34.9), class II (35.0-39.9), and class III (≥40.0) obesity.

MAIN OUTCOME MEASURES: We analyzed the effect of preoperative and intraoperative factors on 30-day outcomes. Continuous variables were compared with Wilcoxon rank-sum tests and proportions with the Fisher exact or χ2 tests. Logistic regression controlled for the effects of multiple risk factors.

RESULTS: Among 5570 patients, class I, II, and III obesity were significantly associated with higher rates of overall complications (44.0%, 50.8%, and 46.6% vs 38.1% for normal-weight patients; p < 0.05). Superficial wound infection was significantly higher in classes I, II, and III (11.6%, 17.8%, and 13.0% vs 8.0% for normal-weight patients; p < 0.05). Operative times for patients in all obesity classes were significantly longer than for normal-weight patients. On multivariate analysis, an obese BMI independently predicted complications; ORs (95% CIs) were 1.36 (1.14-1.62) for class I obesity, 1.99 (1.54-2.54) for class II, and 1.42 (1.02-1.96) for class III.

LIMITATIONS: This study was a retrospective design with limited follow-up.

CONCLUSIONS: Class I, II, and III obese patients were at significantly increased risk for morbidity compared with normal BMI patients. Class II obese patients had the highest rate of complications, a finding that deserves further investigation.

1Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

2Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa

Financial Disclosure: None reported.

Jennifer E. Hrabe and Scott K. Sherman contributed equally to this work.

Correspondence: John C. Byrn, M.D., Division of Gastrointestinal, Minimally Invasive, and Bariatric Surgery, 200 Hawkins Dr, 4577 JCP, Iowa City, IA 52242. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons