Background
Evidence supporting worse outcomes among obese patients is inconsistent. This study
examined associations between body mass index (BMI) and outcomes after major resection
for cancer.
Methods
Data from the 2005–2012 ACS-NSQIP were used to identify cancer patients (≥18 years)
undergoing 1 of 6 major resections: lung surgery, esophagectomy, hepatectomy, gastrectomy,
colectomy, or pancreatectomy. We used crude and multivariable regression to compare
differences in 30-day mortality, serious and overall morbidity, duration of stay,
and operative time among 3 BMI cohorts defined by the World Health Organization: normal
versus underweight, overweight-obese I, and obese II–III. Propensity-scored secondary
assessment and resection type-specific stratified analyses corroborated results.
Results
A total of 529,955 patients met inclusion criteria; 32.06% had normal BMI, 3.45% were
underweight, 32.52% overweight, and 17.76%, 7.51%, and 4.94% obese I–III, respectively.
Risk-adjusted outcomes for underweight patients consistently were worse. Overweight-obese
I fared similarly to patients with normal BMI but had greater odds of isolated complications.
Obese II–III patients experienced only marginally increased odds of morbidity. Analyses
among propensity-scored cohorts and stratified by cancer-resection type reported similar
trends. Worse outcomes were observed among morbidly obese hepatectomy and pancreatectomy
patients.
Conclusion
Evidence-based assessment of outcomes after major resection for cancer suggests that
obese patients should be treated with the aim for optimal oncologic standards without
being hindered by a misleading perception of prohibitively increased perioperative
risk. Underweight and certain types of morbidly obese patients require targeted provision
of appropriate care.
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Article info
Publication history
Published online: May 22, 2015
Accepted:
February 21,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
