Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery


BACKGROUND There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications. METHODS This was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4-month interval (October-December 2014) were eligible for inclusion. The primary outcome was the 30-day major complication rate (Clavien-Dindo grade III-V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital-level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.). RESULTS Of 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30-day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147). CONCLUSION Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

DOI: 10.1002/bjs.10203

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@inproceedings{Drake2016MulticentrePC, title={Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery}, author={T. M. Drake and D. Nepogodiev and S. J. Chapman and J. C. Glasbey and C. Khatri and C. Y. Kong and H. A. Claireaux and M. F. Bath and M. Mohan and L. McNamee and M. Kelly and H. Mitchell and J. E. Fitzgerald and E. M. Harrison and A. Bhangu and I. Antoniou and R. Dean and N. Davies and S. Trecarten and I. Henderson and C. Holmes and J. Wylie and R. H. Shuttleworth and A. Jindal and F. Hughes and P. Gouda and R. Fleck and M. Hanrahan and P. Karunakaran and J. H. Chen and M. C. Sykes and R. K. Sethi and S. Suresh and P. Patel and M. Patel and R. K. Varma and J. Mushtaq and B. Gundogan and W. Bolton and T. Khan and J. Burke and R. Morley and N. Favero and R. Adams and V. Thirumal and E. D. Kennedy and K. K. Ong and Y. H. Tan and J. Gabriel and A. Bakhsh and J. Y. L. Low and A. Yener and V. Paraoan and R. Preece and T. W. Tilston and E. Cumber and S. Dean and T. Ross and E. McCance and H. Amin and L. Satterthwaite and K. D. Clement and R. Gratton and E. D. Mills and S. M. Chiu and G. Hung and N. M. Rafiq and J. D. B. Hayes and K. L. Robertson and K. Dynes and H. C. Huang and S. Assadullah and J. W. Duncumb and R. D. C. Moon and S. X. Poo and J. K. Mehta and K. R. Joshi and R. Callan and J. M. Norris and N. J. Chilvers and H. Keevil and P. Jull and S. Mallick and D. Elf and L. Carr and C. Player and E. C. Barton and A. L. Martin and S. G. Ratu and E. J. Roberts and P. N. Phan and A. R. Dyal and J. E. Rogers and A. D. Henson and N. B. Reid and D. Burke and G. Culleton and S. Lynne and S. Mansoor and C. Brennan and R. Blessed and C. Holloway and A. Hill and T. Goldsmith and S. Mackin and S. Kim and E. Woin and G. Brent and J. Coffin and O. Ziff and Z. Momoh and R. Debenham and M. Ahmed and C. S. Yong and J. C. Wan and H. C. Copley and P. Raut and F. I. Chaudhry and G. Nixon and C. 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