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Obesity paradoxically protective against adverse surgical outcomes

Friday, October 17 2008 | Comments
Evidence Grade 0 What's This?
By David MacDougall

Overweight status and obesity are associated with a decreased risk of 30-day mortality in patients who undergo nonbariatric general surgery, researchers report.

"Conventional surgical wisdom has long held that obesity is a risk factor for poor outcomes following general surgery," said Dr. John Mullen of the Beth Israel Deaconess Medical Center. "Interestingly, recent medical reports have shown that critically and chronically ill overweight and obese patients have paradoxically better outcomes than normal-weight patients."

Dr. Mullen and colleagues reviewed data from the National Surgical Quality Improvement Program, a large, prospective database of information on more than 150,000 surgical patients from 121 medical centers throughout the United States. The study group included 118,707 patients who were categorized as underweight, normal weight, overweight, obese, or morbidly obese according to body mass index criteria developed by the National Institutes of Health.

As expected, the rates of hypertension, diabetes, and dyspnea were higher in the overweight and obese patients than in the other groups. In contrast, the rates of functional dependency, ascites, disseminated cancer, and other select perioperative risk factors were lower in the overweight and obese groups. The overweight and obese patients underwent significantly less complicated surgical procedures than did the underweight group, although operation time was significantly longer in the overweight and obese groups than in the other groups.

The postoperative 30-day mortality rate was 5% in the underweight patients, 1.8% in the normal-weight patients, and 1% in the overweight and obese patients. Postoperative mortality rates were similar in the underweight and morbidly obese patients. The overweight and obese patients were at increased risk of wound infection but not of sepsis, pulmonary complications, and other postoperative complications. A multivariate analysis revealed that, relative to the normal-weight patients, the odds ratios for 30-day postoperative mortality in the overweight and obese patients were 0.85 and 0.73, respectively.

"This study confirms the existence of an obesity paradox among patients undergoing nonbariatric surgery," Dr. Mullen said. "The prejudice that overweight and moderately obese patients are at increased risk for serious adverse outcomes after nonbariatric general surgery is not justified." (Part of: General Surgery 2 Paper Session GS75.)

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