The impact of obesity on minimally invasive colorectal surgery: A report from the Surgical Care Outcomes Assessment Program collaborative - 20/05/21
, Amir L. Bastawrous b, Jennifer A. Kaplan a, Ravi Moonka a, Laila Rashidi c, Vlad V. Simianu aAbstract |
Background |
Operating on obese patients can increase case complexity and result in worse outcomes. We described the incremental impact of BMI on morbidity and outcomes of colorectal operations and whether laparoscopic and robotic(MIS) approaches mitigate this morbidity differently.
Methods |
A retrospective cohort of patients undergoing elective colorectal operations in SCOAP was created to examine the association of increasing BMI on surgical outcomes. Additionally, multivariable logistic regression models were constructed.
Results |
From 2011 to 2019, 22,863 elective colorectal operations (mean age 62, 55% female) were performed at 42 hospitals. Patients had BMI≥30 in 7576(33%) and BMI≥40 in 1180(5%) of operations. After risk adjustment, BMI≥40 was associated with increased conversions(OR1.57,95%CI1.26–1.96), increased combined adverse events(CAE)(OR1.32,95%CI1.15–1.52), and death(OR2.24, 95%CI1.41–3.55)(all p < 0.01). MIS approaches were each associated with lower CAE(lap OR0.49,95%CI0.46–0.53; robot OR0.42,95%CI0.37–0.47), and death(lap OR0.24,95%CI0.18–0.33; robot OR0.18,95%CI0.10–0.35)(all p < 0.01).
Conclusions |
Severe obesity is associated with increased conversion rates and worse short-term outcomes after colorectal surgery, though this trend is partially mitigated with a minimally invasive approach. These findings support the broad application of MIS for colorectal operations in obese patients.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Increasing BMI associated with increased conversion and operative time. |
• | Even with MIS, increasing BMI associated with worse surgical outcomes. |
• | In obese patients, robotics associated with lower conversion and better outcomes. |
• | After risk adjustment, BMI ≥40 tipping point for worse outcomes. |
Keywords : Morbid obesity, Colorectal surgery, Laparoscopic, Robotic
Plan
Vol 221 - N° 6
P. 1211-1220 - juin 2021 Retour au numéro
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