J.M. Morton1, L. Ying1, M.S. Moore1, J.S. Canner1, E. Schneider1 1Yale University School Of Medicine, Surgery, New Haven, CT, USA
Introduction: Obesity affects surgery outcomes in a variable manner both in prevalence and surgery type. This study will demonstrate the impact of stages of obesity upon outcomes and which surgeries are most impacted by obesity.
Methods: The capture algorithm for this data analysis was for NSQIP Public Use File for 2022 and to include elective procedures only (including only admissions from home and case type elective), procedures with height and weight variables available and age >18 only. Procedures were divided into four Body Mass Index (BMI) categories: <30, 30-40, 40-50, >50. Demographic, comorbidity and outcome data were analyzed across BMI categories with ANOVA test. A logistic regression analysis was employed for the dependent variable of any complication with demographic, BMI, and comorbidity serving as independent variables. An array of the 50 most common procedures by BMI Category was also generated.
Results: With over 800,000 procedures analyzed, total complications were noted to positively correlate to BMI: <30: 13.3%; 30-40: 12.25; 40-49: 13.10; >50: 15.17. BMI also played a role in specific complications such as septic shock <30: 0.35%; 30-40: 0.26; 40-49: 0.25; >50: 0.46 and pulmonary embolus <30: 0.25%; 30-40: 0.35; 40-49: 0.36; >50: 0.42. The logistic regression analysis revealed a dose-dependent effect for ascending BMI: <30: 1 Odds Ratio (OR); 30-40: 0.94; 40-49: 1.03; >50: 1.25. This BMI effect was attenuated by increasing age where the OR for BMI declined to 1.1 for age >65. Throughout the BMI Categories, total joint replacement, cholecystectomy, and mastectomy were consistently represented while as BMI increased bariatric, hysterectomy, caesarean section, thyroid procedures were more often represented.
Conclusion: This study demonstrates that patients with obesity, especially those with BMI>50, have more complications. Given that obesity is a modifiable risk factor, preoperative weight reduction represents an additional opportunity for prehabilitation.