BODY MASS INDEX AND OUTCOMES IN PATIENTS UNDERGOING ABDOMINAL SURGERY: A PROSPECTIVE STUDY
Abstract
Background: Obesity has long been considered a risk factor for poor outcomes from a variety of surgical procedures, yet recent studies of critically and chronically ill patients suggest that overweight and obese patients may paradoxically have better outcomes or has no effect on outcome. This unexpected association between improved outcomes and mild obesity has been described as the “Obesity Paradox”(9).
Material and Methods: We conducted a prospective study of 275 patients undergoing abdominal surgery in NSCB Medical College, Jabalpur, from Feb 2015 to Sep 2016 to examine effect of BMI on postoperative day morbidity and mortality. A pre-operative proforma was filled after taking detailed history, examination and conducting few investigations for each patient. A post-operative proforma was filled after following the patient for 30 days.
Results: In our study, we found that out of total 275 patients, 84 (30.54%) were underweight, 150 (54.54%) were having normal BMI, 31 (11.27%) were overweight and 10 (3.63%) were obese. In our study, out of total 275 patients, 60 were female(21.8%) and 215 were male patients(78.2%). Mean duration of hospital stay was found to be 16 day in underweight group, 12 day in normal BMI group, 12 day in overweight group and 19 day in obese group. Mortality was present in 7(8.30%) out of 84 underweight patients, 3(2%) out of 150 normal BMI patients, 3(9.70%) out of 31 overweight patients and 1(10%) out of 10 obese patients. P value was found to be statistically significant for mortality in underweight patient and overweight patient. Underweight and obese patients had higher rate of wound dehiscence and SSI in comparison to normal BMI group. We found that obesity was not an independent risk factor for post op complications such as post op pneumonia, unplanned intubation, renal insufficiency, thromboembolic complications, myocardial infarction, blood transfusions and urinary tract infections.
Conclusion: We found that being underweight is associated with high mortality in patients undergoing abdominal surgery. But obesity is not associated with high mortality in these patients. Our study confirms the existence of “obesity paradox”. We found that obesity was only an independent predictor of wound infection and not other post op complications.Keywords
References
Buck DL, and Muller MH. (2014). “Influence of body mass index on mortality after surgery for perforated peptic ulcer”, Br J Surg, Jul, Vol.101(8), pp.993-999.
Davenport DL, Xenos ES, Hosokawa P, Radford J, Henderson WG, and Endean ED. (2009). “The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality”, J Vasc Surg, Jan, Vol.49(1), pp.140-147.
Dindo D, Muller MK, Weber M, and Clavien PA. (2003). “Obesity in general elective surgery”, Lancet, Jun 14, Vol.361(9374), pp.2032-2035.
Engelman DT, Adams DH, and Byrne JG, et al. (1999). “Impact of body mass index and albumin on morbidity and mortality after cardiac surgery”, J Thorac Cardiovasc Surg, Vol.118(5), pp.866-873.
Gallagher D, Visser M, Sep´ulveda D, Pierson RN, Harris T, aand Heymsfield SB. (1996). “How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?”, Am J Epidemiol, Vol.143, pp.228-239.
Gurm HS, Brennan DM, Booth J, Tcheng JE, Lincoff AM, and Topol EJ. (2002). “Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox)”, Am J Cardiol, Vol.90(1), pp.42-45.
Katzmarzyk PT, Reeder BA, Elliott S, Joffres MR, Pahwa P, Raine KD, Kirkland SA, and Paradis G. (2012). “Body mass index and risk of cardiovascular disease, cancer and all-cause mortality”, Can J Public Health, Mar-Apr, Vol.103(2), pp.147-151.
Mullen JT, Davenport DL, and Hutter MM, et al. (2008). “Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery”, Ann Surg Oncol, Vol.15(8), pp.2164-2172.
Mullen JT, Moorman DW, and Davenport DL. (2009). “The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery”, Ann Surg, Jul, Vol.250, pp.166-172.
Park DW, Kim YH, Yun SC, Ahn JM, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, and Park SJ. (2013). “Association of body mass index with major cardiovascular events and with mortality after percutaneous coronary intervention”, Circ Cardiovasc Interv, Apr, Vol.6(2), pp.146-153.
Reeves BC, Ascione R, Chamberlain MH, and Angelini GD. (2003). “Effect of Body Mass Index on Early Outcomes in Patients Undergoing Coronary Artery Bypass Surgery”, J Am Coll Cardiol, Vol.42(4), pp.668-676.
Turrentine FE, Hanks JB, Schirmer BD, Stukenborg GJ. (2012). “The Relationship Between Body Mass Index and 30-Day Mortality Risk, by Principal Surgical Procedure”, Arch Surg, Vol.147(3), pp.236-242.
Valentijn TM, Galal W, Tjeertes EK, Hoeks SE, Verhagen HJ, and Stolker RJ. (2013). “The obesity paradox in the surgical population”, Surgeon, Vol.11, pp.169-176.
Refbacks
- There are currently no refbacks.
Send mail to ijsss@ijsss.com with questions or comments about this web site.
International Journal of Surgery and Surgical Sciences, All rights reserved.