World Journal of Surgery

, Volume 39, Issue 10, pp 2376–2385 | Cite as

The Effect of Body Mass Index on Perioperative Outcomes After Major Surgery: Results from the National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011

  • Akshay Sood
  • Firas Abdollah
  • Jesse D. Sammon
  • Kaustav Majumder
  • Marianne Schmid
  • James O. Peabody
  • Mark A. Preston
  • Adam S. Kibel
  • Mani Menon
  • Quoc-Dien TrinhEmail author
Original Scientific Report



Obesity is associated with poor surgical outcomes and disparity in access-to-care. There is a lack of quality data on the effect of body mass index (BMI) on perioperative outcomes. Accordingly, we sought to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing major surgery.


Participants included individuals undergoing one of 16 major surgery (cardiovascular, orthopedic, oncologic; n = 141,802) recorded in the ACS-NSQIP (2005–2011). Outcomes evaluated included complications, blood transfusion, length-of-stay (LOS), re-intervention, readmission, and perioperative mortality. Multivariable-regression models assessed the independent-effect of BMI on outcomes.


Nearly, 74  % of patients had a BMI disturbance; the majority being overweight (35.3  %) or obese (29.8  %). Morbidly obese patients constituted a small but significant proportion of the patients (5.7 %; n = 8067). In adjusted-analyses, morbidly obese patients had significantly increased odds of wound complications in 15 of the examined procedures, of renal complications after 6-procedures, of thromboembolism after 5-procedures, of pulmonary, septic and UTI complications after 2-procedures, and of cardiovascular complications after CABG. Conversely, obese/overweight patients, except for increased odds of wound complications after select procedures, had significantly decreased odds of perioperative mortality, prolonged-LOS and blood transfusion relative to normal BMI patients after 4, 8, and 9 of the examined procedures.


The prevalence of BMI derangements in surgical patients is high. The effect of BMI on outcomes is procedure specific. Patients with BMI between 18.5 and 40-kg/m2 at time of surgery fare equally well with regard to complications and mortality. However, morbidly obese patients are at-risk for postsurgical complications and targeted preoperative-optimization may improve outcomes and attenuate disparity in access-to-care.


Obese Patient Coronary Artery Bypass Grafting Wound Complication Abdominal Aortic Aneurysm Repair Underweight Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Quoc-Dien Trinh is supported by the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at Brigham and Women’s Hospital; The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflict of interest


Supplementary material

268_2015_3112_MOESM1_ESM.doc (210 kb)
Supplementary material 1 (DOC 210 kb)


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Akshay Sood
    • 1
    • 3
  • Firas Abdollah
    • 1
  • Jesse D. Sammon
    • 1
  • Kaustav Majumder
    • 2
  • Marianne Schmid
    • 3
  • James O. Peabody
    • 1
  • Mark A. Preston
    • 3
  • Adam S. Kibel
    • 3
  • Mani Menon
    • 1
  • Quoc-Dien Trinh
    • 3
    Email author
  1. 1.Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology InstituteHenry Ford Health SystemDetroitUSA
  2. 2.Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  3. 3.Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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