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Effects of body mass index (BMI) on surgical outcomes: a nationwide survey using a Japanese web-based database

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Abstract

Purpose

To define the effects of body mass index (BMI) on operative outcomes for both gastroenterological and cardiovascular surgery, using the National Clinical Database (NCD) of the Japanese nationwide web-based database.

Methods

The subjects of this study were 288,418 patients who underwent typical surgical procedures between January 2011 and December 2012. There were eight gastroenterological procedures, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy of >1 segment excluding the lateral segment, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis (n = 232,199); and five cardiovascular procedures, including aortic valve replacement, total arch replacement (TAR), descending thoracic aorta replacement (descending TAR), and on- or off-pump coronary artery bypass grafting (n = 56,219). The relationships of BMI with operation time and operative mortality for each procedure were investigated, using the NCD.

Results

Operation times were longer for patients with a higher BMI. When a BMI cut-off of 30 was used, the operation time for obese patients was significantly longer than that for non-obese patients, for all procedures except esophagectomy (P < 0.01). The mortality rate based on BMI revealed a U-shaped distribution, with both underweight and obese patients having high mortality rates for almost all procedures.

Conclusions

This Japanese nationwide study provides solid evidence to reinforce that both obesity and excessively low weight are factors that impact operative outcomes significantly.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Motonari Ri, Susumu Aikou & Yasuyuki Seto

  2. National Clinical Database (NCD), Tokyo, Japan

    Hiroaki Miyata

  3. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan

    Kohei Akazawa

  4. Department of Clinical Medicine, School of Pharmacy, Kitasato University, Kanagawa, Japan

    Masahiro Takeuchi

  5. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

    Yoshiro Matsui

  6. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Hiroyuki Konno, Mitsukazu Gotoh & Masaki Mori

  7. Japan Cardiovascular Surgery Database Organization, Tokyo, Japan

    Noboru Motomura & Shinichi Takamoto

  8. Department of Cardiovascular Surgery, Osaka University of Medicine, Osaka, Japan

    Yoshiki Sawa

  9. Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan

    Hiroyuki Kuwano

  10. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Norihiro Kokudo

Authors
  1. Motonari Ri
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  2. Hiroaki Miyata
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  3. Susumu Aikou
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  4. Yasuyuki Seto
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  5. Kohei Akazawa
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  6. Masahiro Takeuchi
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  7. Yoshiro Matsui
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  8. Hiroyuki Konno
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  9. Mitsukazu Gotoh
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  10. Masaki Mori
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  11. Noboru Motomura
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  12. Shinichi Takamoto
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  13. Yoshiki Sawa
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  14. Hiroyuki Kuwano
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  15. Norihiro Kokudo
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Corresponding author

Correspondence to Yasuyuki Seto.

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Conflict of interest

None of the authors has any conflicts of interest to disclose.

Funding/support

This study was funded by the Japan Surgical Society.

Role of the funders/sponsors

The NCD data used in this study were collected by the Japan Surgical Society. The Japan Surgical Society reviewed and approved this article before its submission.

Additional information

On behalf of the Japan Surgical Society.

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Ri, M., Miyata, H., Aikou, S. et al. Effects of body mass index (BMI) on surgical outcomes: a nationwide survey using a Japanese web-based database. Surg Today 45, 1271–1279 (2015). https://doi.org/10.1007/s00595-015-1231-2

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  • DOI: https://doi.org/10.1007/s00595-015-1231-2

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