Does BMI Predict Outcomes in Emergency General Surgery?
*Matthew M. Fleming1, *Jiajun Luo2, *Yawei Zhang2,3, Kevin Y. Pei1
1Yale School of Medicine, Department of Surgery, New Haven, CT; 2Section of Surgical Outcomes and Epidemiology. Department of Surgery, Yale School of Medicine, New Haven, CT; 3Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
Objective: To determine if Body Mass Index (BMI) impacts outcomes in the recently defined field of Emergency General Surgery.
Design: We performed a retrospective review of ACS-NSQIP (2010-2016) to calculate risk adjusted morbidity and mortality for the 7 most common emergency general surgery procedures as defined by the AAST: perforated ulcer, appendectomy, cholecystectomy, laparotomy, partial colectomy, small bowel resection, and lysis of adhesions.
Setting: ACS NSQIP participating hospitals.
Patients/Participants: Patients undergoing emergency general surgery procedures from 2010-2016.
Interventions (if any): None.
Main Outcome Measures: Adjusted morbidity and mortality stratified by BMI classification.
Results: There were 310,643 patients included for analysis. In general, the BMI ≥40 group had more comorbidities than other BMI strata. When analyzing the 7 procedures together, BMI <18.5 and BMI ≥40 had significantly elevated risk for postoperative complications (OR 1.21 95%CI 1.14-1.28 and OR 1.20 95% CI 1.15-1.24, respectively) while BMI <18.5 significantly elevated risk for reoperation (OR 1.49, 95%CI1.15-1.93) and mortality (OR 1.65, 95%CI 1.65-1.66). Notably, elevated BMI was a risk for increased rates of complications when procedures were analyzed individually for BMI ≥40: perforated ulcer OR 2.18 (CI 1.58-3.01), appendectomy OR 1.54 (CI 1.31-1.80), cholecystectomy OR 1.21 (CI 1.20-1.21), laparotomy OR 1.97 (CI 1.59-2.44), colon resection OR 1.46 (CI 1.39-1.54), and small bowel resection OR 1.46 (CI 1.39-1.54).
Conclusions: The extremes of Body Mass Index are both associated with increased postoperative complications. Contrary to current literature, very high BMI may not be protective in patients undergoing emergency general surgery.