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Impact of Obesity on Postoperative and Long-term Outcomes in a General Surgery Population: A Retrospective Cohort Study

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An Erratum to this article was published on 23 August 2013

Abstract

Background

The obesity paradox has been demonstrated postoperatively in several surgical populations, but only a few studies have reported long-term survival. This study evaluates the presence of the obesity paradox in a general surgery population, reporting both postoperative and long-term survival.

Methods

This retrospective study included 10,427 patients scheduled for elective, noncardiac surgery. Patients were classified as underweight (body mass index (BMI) < 18.5 kg/m2); normal weight (BMI 18.5–24.9 kg/m2); overweight (BMI 25.0–29.9 kg/m2); obesity class I (BMI 30.0–34.9 kg/m2); obesity class II (BMI 35.0–39.9 kg/m2); and obesity class III (BMI ≥ 40.0 kg/m2). Study endpoints were 30-day postoperative and long-term mortality, including cause-specific mortality. Multivariable analyses were used to evaluate mortality risks for each BMI category.

Results

Within 30 days after surgery, 353 (3.4 %) patients died. Overweight was the only category associated with postoperative mortality, showing improved survival [odds ratio 0.7; 95 % confidence interval (CI) 0.6–0.9]. During the long-term follow-up 4,884 (47 %) patients died. Underweight patients had the highest mortality risk [hazard ratio (HR) 1.4; 95 % CI 1.2–1.6), particularly due to high cancer-related deaths. In contrast, overweight and obese patients demonstrated improved survival (overweight: HR 0.8, 95 % CI 0.8–0.9; obesity class I: HR 0.7, 95 % CI 0.7–0.8; obesity class II: HR 0.7, 95 % CI 0.6–0.9; obesity class III: HR 0.7, 95 % CI 0.5–1.0), mainly because of a strongly reduced risk of cancer-related death.

Conclusions

In this surgical population the obesity paradox was validated at the long term, mainly because of decreased cancer-related deaths among obese patients.

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Acknowledgments

Dr. Valentijn is supported by an unrestricted research grant from “Lijf en Leven,” Rotterdam, The Netherlands.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Anesthesiology, Erasmus University Medical Center, Room H-1273, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Tabita M. Valentijn, Wael Galal, Sanne E. Hoeks, Yvette R. van Gestel & Robert J. Stolker

  2. Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

    Tabita M. Valentijn, Wael Galal & Hence J. Verhagen

  3. Eindhoven Cancer Registry, Comprehensive Cancer Center South (IKZ), Eindhoven, The Netherlands

    Yvette R. van Gestel

Authors
  1. Tabita M. Valentijn
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  2. Wael Galal
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  3. Sanne E. Hoeks
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  4. Yvette R. van Gestel
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  5. Hence J. Verhagen
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  6. Robert J. Stolker
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Corresponding author

Correspondence to Robert J. Stolker.

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Valentijn, T.M., Galal, W., Hoeks, S.E. et al. Impact of Obesity on Postoperative and Long-term Outcomes in a General Surgery Population: A Retrospective Cohort Study. World J Surg 37, 2561–2568 (2013). https://doi.org/10.1007/s00268-013-2162-y

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  • DOI: https://doi.org/10.1007/s00268-013-2162-y

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