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Obesity, Regardless of Comorbidity, Influences Outcomes After Colorectal Surgery—Time to Rethink the Pay-for-Performance Metrics?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

An elevated body mass index (BMI) is associated with increased morbidity and mortality after colorectal surgery. While coexistent comorbid conditions are captured in some determinations of case-severity, BMI itself is not factored into pay for performance (P4P) initiatives. From the National Surgical Quality Improvement Program database 2006–2011, obese (BMI ≥30 kg/m2) and nonobese (BMI <30 kg/m2) patients with and without comorbidity undergoing colorectal resection were identified. Pre- and intraoperative factors as well as postoperative outcomes were compared. Of 130,415 patients, 31.3 % were obese. 80.4 % of obese and 72.9 % of nonobese patients had comorbid conditions. Among obese patients, overall rates of surgical site infection (SSI), wound dehiscence, and various medical complications were significantly higher for those with comorbidity compared to those without (p < 0.001 for all). Obese patients with comorbidity overall had greater risk of renal failure and urinary tract infection than nonobese patients. Regardless of comorbidity, obese patients more commonly had pulmonary embolism, failure to wean from the ventilator, overall SSI, and wound dehiscence. Comorbid factors associated with obesity influence outcomes; however, obesity itself in their absence is associated with worse outcomes. This supports inclusion of obesity as an independent determinant of case-severity, quality, and reimbursement after colorectal surgery.

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Conflict of Interest

Authors have nothing to disclose.

Authors’ Contributions

Iyare O. Esemuede and Ravi P. Kiran made substantial contributions to the conception and design of the project as well as acquisition, analysis, and interpretation of data. Iyare O. Esemuede, Ravi P. Kiran, Alice Murray, Steven A. Lee-Kong, and Daniel L. Feingold made significant contributions to drafting and revising the article. Final approval of the version to be published was done by all four authors.

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  1. New York Presbyterian Columbia University Medical Center, 177 Fort Washington Ave, 7th Floor South Knuckle, New York, NY, 10032, USA

    Iyare O. Esemuede, Alice C A Murray, Steven A. Lee-Kong, Daniel L. Feingold & Ravi P. Kiran

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  1. Iyare O. Esemuede
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  2. Alice C A Murray
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  3. Steven A. Lee-Kong
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Correspondence to Ravi P. Kiran.

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Esemuede, I.O., Murray, A.C.A., Lee-Kong, S.A. et al. Obesity, Regardless of Comorbidity, Influences Outcomes After Colorectal Surgery—Time to Rethink the Pay-for-Performance Metrics?. J Gastrointest Surg 18, 2163–2168 (2014). https://doi.org/10.1007/s11605-014-2672-4

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  • DOI: https://doi.org/10.1007/s11605-014-2672-4

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