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Morbid Obesity is Associated with Increased Mortality, Surgical Complications, and Incremental Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery

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Abstract

Background

Morbid obesity (Basic Mass Index ≥ 40 kg/m2) leads to increased long-term mortality after colorectal cancer (CRC) surgery. Little is known about its effects on peri-operative CRC surgery outcomes.

Methods

85,300 discharges for CRC surgery were identified using the redesigned 2012 National Inpatient Sample. Outcomes of interest were mortality, healthcare charges, and surgical outcomes in morbidly obese patients which were compared to those in nonobese patients.

Results

There were 4385 (5.14%) morbidly obese patients who underwent CRC surgery during the study period. Morbid obesity was associated with younger age, females, and African Americans in our study (p < 0.05). Morbidly obese patients had higher prevalence of CRC peri-operative co-morbidities, surgical complications, and conversions from laparoscopic to open surgery. On multivariate analysis, morbid obesity led to an increased CRC surgery peri-operative mortality (OR 1.85, 95 % CI 1.15, 2.97). Mortality remained significant even after adjusting for surgical complications (OR 1.79, 95 % CI 1.12, 2.88). Morbidly obese patients undergoing CRC also had a prolonged length of hospitalization (1.22 day, 95 % CI 0.67, 1.78), a $15,582 increase in total hospital charges (95 % CI 8419, 22,745), and increased disposition to short-term rehabilitation facilities (OR 2.25, 95 % CI 1.79, 2.84).

Conclusion

Analysis of national level data demonstrates that morbidly obese patients have an increased CRC surgery peri-operative mortality with higher prevalence of co-morbidities, surgical complications, and more health care resource utilization. Future research efforts should concentrate on ameliorating these outcomes in morbidly obese patients.

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Abbreviations

BMI:

Body Mass Index

CI:

Confidence interval

CRC:

Colorectal cancer

HCUP:

Healthcare Cost and Utilization Project

ICD-9CM:

International Classification of Diseases Ninth Revision Clinical Modification

NIS:

National Inpatient Sample

OR:

Odds ratio

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Author contributions

Dr. Hussan was involved in conception, design, interpretation of data, and the drafting and critical revision of the manuscript. Dr. Hinton was involved in 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. Gray, Krishna, Conwell, and Stanich were involved in 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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No financial support was utilized in the creation of this project.

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Authors and Affiliations

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

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

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

    Somashekar G. Krishna & Darwin L. Conwell

  3. Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA

    Alice Hinton

Authors
  1. Hisham Hussan
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  2. Darrell M. Gray II
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Correspondence to Hisham Hussan.

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Hussan, H., Gray, D.M., Hinton, A. et al. Morbid Obesity is Associated with Increased Mortality, Surgical Complications, and Incremental Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery. World J Surg 40, 987–994 (2016). https://doi.org/10.1007/s00268-015-3358-0

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  • DOI: https://doi.org/10.1007/s00268-015-3358-0

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