Abstract
Obesity and diabetes are risk factors for postoperative complications. Independent vs. additive effects on perioperative outcomes are understudied. We measured the association between obesity, diabetes, and both on postcesarean complications. Retrospective cohort study of patients who underwent cesarean delivery at 182 US hospitals in 2019 (NSQIP). Missing BMI or diabetes were excluded. Patients were categorized as neither obesity nor diabetes (referent), obesity alone, diabetes alone, or obesity and diabetes. Primary outcome was a composite of severe maternal morbidity (SMM), defined by the CDC. Secondary outcomes were operative time, surgical site infection (SSI), length of postop stay and other complications. Multivariable logistic regression and general linear models with poisson or gamma distribution and log link were used to estimate measures of association. Of 9727 patients, 32% had neither obesity nor diabetes, 61% obesity alone, 1% diabetes alone, and 6% obesity and diabetes. Groups differed by age, race, HTN, and bleeding disorders (Table). Insulin-dependence did not differ between those who had diabetes alone versus obesity and diabetes (p=0.99). SMM occurred in 2% and did not differ by obesity and/or diabetes (Figure). Odds of SSI was higher in those with obesity and diabetes as well as obesity alone. Obesity was associated with higher odds of readmission. Operative time was longer in those with obesity and diabetes (adjusted mean 56.8min, 95% CI 52.8-61.2) and obesity alone (55.3min, 95% CI 51.1-59.1) vs. neither obesity nor diabetes (53.7 min, 95% CI 50.2-57.0; p< 0.05 for both). Postoperative length of stay was longer in those with diabetes (3.1 days, 95% CI 2.7-3.6) vs. neither obesity nor diabetes (2.7 days, 95% CI 2.5-3.0; p< 0.05). There was no difference in SMM between groups. Differences in postop stay and operative times are small and may not be clinically significant. Increased SSI and readmission in obese patients should be considered when considering surgical bundles, perioperative protocols, and postoperative plans to optimize outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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