E. Lagazzi1, M. Abiad1, W. Rafaqat1, V. Panossian1, I. Nzenwa1, A. Hoekman1, S. Arnold1, K. Ghaddar1, J. J. Parks1, C. N. Paranjape1, G. C. Velmahos1, H. M. Kaafarani1, J. O. Hwabejire1 1Massachusetts General Hospital, Division Of Trauma, Emergency Surgery, And Surgical Critical Care, Boston, MA, USA
Introduction:
Obesity is increasingly prevalent both nationwide and in the emergency general surgery (EGS) population. While previous studies have shown that obesity is protective against mortality and morbidity following EGS procedures, the impact of body mass index (BMI) on intraoperative decision-making and postoperative outcomes remains understudied.
Methods:
The NSQIP 2015-2019 database was used to identify all adult patients undergoing an emergent exploratory laparotomy for EGS conditions. We excluded all patients with disseminated cancer. Our primary outcome was 30-day postoperative mortality. Secondary outcomes included composite 30-day morbidity, delayed fascial closure, reoperation, operative time, and hospital length of stay (LOS). Operative time and hospital length of stay were categorized as binary variables according to the median value. Patients were stratified based on their BMI in underweight, normal weight, class I obesity, class II obesity, and class III obesity according to the World Health Organization (WHO) classification. Multivariable logistic regression models were used to identify the impact of the patient’s BMI on each outcome of interest while adjusting for patient demographics, comorbidities, laboratory tests, preoperative and intraoperative variables.
Results:
We identified 78,578 patients, of which 3,121 (3.97%) were categorized as underweight, 23,661 (30.11%) as normal weight, 22,072 (28.09%) as overweight, 14,287 (18.18%) with class I obesity, 7,370 (9.38%) with class II obesity, and 8,067 (10.27%) with class III obesity. Following the multivariate analysis, being underweight was identified as an independent predictor of mortality (aOR 1.65, 95% confidence interval [CI] 1.39-1.97, p<0.001) following EGS procedures. Class III obesity was identified as a risk factor for 30-day postoperative morbidity (aOR 1.14, 95% CI, 1.03-1.26, p=0.015). The risk of undergoing a delayed fascial closure was directly correlated to the obesity class: obesity class I (aOR 1.24, 95% CI, 1.09-1.42, p=0.001), class II (aOR 1.37, 95% CI, 1.17-1.61, p<0.001), and class III (aOR 1.59, 95% CI, 1.36-1.86, p<0.001). Similarly, an increase in obesity class was also associated with a stepwise increase in the risk of undergoing a reoperation, having a prolonged operative time, and experiencing an extended hospital length of stay (Table 1).
Conclusion:
Obesity class is associated with an increase in delayed fascial closure, longer operative time, reoperation rates, and extended hospital length of stay. These findings warrant further studies investigating how the patient’s BMI impacts intraoperative factors, surgical decision-making, and hospital costs.
