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Prior Bariatric Surgery Is Linked to Improved Colorectal Cancer Surgery Outcomes and Costs: A Propensity-Matched Analysis

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Abstract

Background

Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown.

Methods

The National Inpatient Sample Database (2006–2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m2 and BMI >35 kg/m2) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization.

Results

There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012. Prior bariatric surgery patients were younger, with fewer comorbidities, and had less emergency CRC surgery admissions (p < 0.05). Multivariate analyses revealed no adverse association (OR 0.54, 95 % CI = 0.16 to 1.79) between prior bariatric surgery and CRC perioperative mortality. Notably, multivariate analysis revealed that bariatric surgery patients undergoing CRC surgery had fewer accidental surgical lacerations (OR 0.38, 95 % CI = 0.15 to 0.93), shorter hospitalizations (−1.85 days, 95 % CI = 2.03 to 1.67), decreased total hospital costs (US$−5374, 95 % CI = −5935 to −4813) and lower disposition to short-term rehabilitation facilities (OR 0.65, 95 % CI = −0.43 to 0.97). Propensity score matched analysis validated these reductions in surgical complications and health care utilization in bariatric surgery patients, which were further more pronounced when bariatric surgery patients were restricted to BMI ≤35 kg/m2.

Conclusions

Analysis of national-level data demonstrates that prior bariatric surgery is associated with fewer colorectal cancer surgical complications and improved health care resource utilization compared to morbidly obese patients. These findings emphasize and extend the therapeutic effect of bariatric surgery to the colorectal cancer perioperative setting.

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Acknowledgments

Author Contributions

Dr. Hussan was involved in the conception, design, interpretation of data, and the drafting and critical revision of the manuscript. Dr. Porter was involved in the study design, performed the acquisition and the statistical analysis of the data, and provided critical revision of the manuscript. The above authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Stanich, Gray, Krishna, Conwell, and Clinton were involved in the design, interpretation of data, and critical revision of the manuscript. All gave final approval of the submitted manuscript and take responsibility for the integrity of the work.

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Authors and Affiliations

  1. Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Medical Center, 395 W 12th Ave, Suite 240, Columbus, OH, 43210, USA

    Hisham Hussan, Peter P. Stanich & Darrell M. Gray II

  2. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA

    Somashekar G. Krishna & Darwin L Conwell

  3. Center of Biostatistics, The Ohio State University, Columbus, OH, USA

    Kyle Porter

  4. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA

    Steven K. Clinton

  5. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Hisham Hussan, Darrell M. Gray II, Darwin L Conwell & Steven K. Clinton

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  1. Hisham Hussan
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  2. Peter P. Stanich
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Correspondence to Hisham Hussan.

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The authors do not have any relevant conflicts of interest (including relevant financial interests, activities, relationships and/or affiliations).

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This article does not contain any studies with human participants or animals performed by any of the authors. For this type of retrospective study, formal consent is not required.

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Hussan, H., Stanich, P.P., Gray, D.M. et al. Prior Bariatric Surgery Is Linked to Improved Colorectal Cancer Surgery Outcomes and Costs: A Propensity-Matched Analysis. OBES SURG 27, 1047–1055 (2017). https://doi.org/10.1007/s11695-016-2421-8

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  • DOI: https://doi.org/10.1007/s11695-016-2421-8

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