Abstract
BackgroundObesity is generally believed to be a risk factor for the development of postoperative complications. Although being obese is associated with medical hazards, recent literature shows no convincing data to support this assumption. Moreover a paradox between body mass index and survival is described. This study was designed to determine influence of body mass index on postoperative complications and long-term survival after surgery.MethodsA single-centre prospective analysis of postoperative complications in 4293 patients undergoing general surgery was conducted, with a median follow-up time of 6.3 years. We analyzed the impact of bodyweight on postoperative morbidity and mortality, using univariate and multivariate regression models.ResultsThe obese had more concomitant diseases, increased risk of wound infection, greater intraoperative blood loss and a longer operation time. Being underweight was associated with a higher risk of complications, although not significant in adjusted analysis. Multivariate regression analysis demonstrated that underweight patients had worse outcome (HR 2.1; 95 % CI 1.4-3.0), whereas being overweight (HR 0.6; 95 % CI 0.5–0.8) or obese (HR 0.7; 95 % CI 0.6–0.9) was associated with improved survival.ConclusionObesity alone is a significant risk factor for wound infection, more surgical blood loss and a longer operation time. Being obese is associated with improved long-term survival, validating the obesity paradox. We also found that complication and mortality rates are significantly worse for underweight patients. Our findings suggest that a tendency to regard obesity as a major risk factor in general surgery is not justified. It is the underweight patient who is most at risk of major postoperative complications, including long-term mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0096-7) contains supplementary material, which is available to authorized users.
Highlights
Obesity is generally believed to be a risk factor for the development of postoperative complications
Exclusion criteria were procedures performed under local anesthesia, patients younger than 14 years old and assisting surgery for a specialism other than the surgery department
Multivariate regression analysis, adjusting for confounders, demonstrated that underweight patients undergoing general surgery again had the worst outcome (HR 2.1; 95 % CI 1.4–3.0), whereas being overweight (HR 0.6; 95 % CI 0.5–0.8) or obese (HR 0.7; 95 % CI 0.6–0.9) is associated with improved survival (Table 4). In this large sample of patients we found that obesity is a significant risk factor for surgical site infection, more surgical blood loss and a longer operation time, these complications did not affect long-term survival
Summary
Obesity is generally believed to be a risk factor for the development of postoperative complications. Being obese is associated with medical hazards, recent literature shows no convincing data to support this assumption. A paradox between body mass index and survival is described. This study was designed to determine influence of body mass index on postoperative complications and long-term survival after surgery. In the United States, more than one-third of the adult population is currently obese [1]. As in Europe, obesity has reached epidemic proportions, with considerable geographic variation [2]. Being obese is associated with increased risk of a number of medical conditions, including diabetes, coronary artery disease, hypertension, hyperlipidemia and certain types of cancer [3].
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