Obesity Increases Complications in Abdominal Surgery

TOPLINE:

Obesity is associated with longer operative times and higher odds of complications than normal body mass index (BMI) in patients undergoing abdominal surgery.

METHODOLOGY:

• Although surgeons encounter challenges such as longer operative times and higher complication rates when operating on patients with obesity, they are paid a fixed amount for procedures, not reflecting the additional work often needed.
• Researchers analyzed data from a large registry to assess the associations between overweight and obesity categories and objective measures of physician work across a variety of high-volume abdominal procedures, identified using specific current procedural terminology codes.
• To assess its impact on surgical outcomes, BMI was calculated and categorized as follows: < 18.5 (underweight), 18.5-25 (normal), 25-29.9 (overweight), 30-34.9 (class 1 obesity), 35-39.9 (class 2 obesity), 40-49.9 (class 3 obesity), and ≥ 50 (extreme obesity).
• The primary outcomes included operative time and complication rates, which were measured for up to 30 days after surgery.

TAKEAWAY:

• A total of 158,692 operations were included, covering 10 common abdominal procedures.
• Surgical operations were associated with longer operative times in patients with obesity across all procedures and in patients with overweight for 8 out of 10 procedures than in patients with normal BMI.
• Compared with people with normal BMI, operative times increased by 5.6% for those with overweight, 10.6% for those with class 1 obesity, 14.7% for those with class 2 obesity, 18.9% for those with class 3 obesity, and 26.8% for those with extreme obesity.
• Obesity was associated with higher odds of both any complication and serious complications, with a dose-response effect observed across all BMI categories, whereas being overweight was linked to higher odds of any complication alone (odds ratio, 1.06).
• Wound complications, pulmonary embolism, and renal insufficiency were identified as key drivers of increased complication rates in patients with overweight or obesity.

IN PRACTICE:

“Systems are needed to compensate surgeons for this growing challenge in order to ensure all patients continue to have equal access to care,” the authors wrote.

SOURCE:

This study was led by Christopher P. Childers, MD, PhD, Department of Surgery, University of Washington, Seattle. It was published online in the Journal of the American College of Surgeons.

LIMITATIONS:

Operative time and complication rates may not have fully represented the totality of extra work required to care for patients with obesity. The analysis focused on only average increases in operative time and complication rates across all BMI categories, potentially overlooking outliers that could have benefited from additional compensation. The statistical model used was simplistic and did not establish a causal relationship between obesity and physician work. Additionally, the sample drew heavily from academic institutions, which may have limited generalizability to a broader population.

DISCLOSURES:

No funding sources were disclosed. One author reported being a paid consultant for Cook Biotech Inc, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.