The Relationship Between Body Mass Index and 30-Day Mortality Risk, by Principal Surgical Procedure | Obesity | JAMA Surgery | JAMA Network
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1.
 Obesity has reached epidemic proportions globally, WHO warned. PRLOG Press Release Distribution Web site. http://www.prlog.org/10541628-obesity-has-reached-epidemic-proportions-globally-who-warned.html. Accessed April 19, 2010
2.
Mokdad AH, Ford ES, Bowman BA,  et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.  JAMA. 2003;289(1):76-7912503980PubMedGoogle ScholarCrossref
3.
National Center for Health Statistics.  Chartbook on Trends in the Health of Americans. Health, United States, 2006. Hyattsville, MD: Public Health Service; 2006
4.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000.  JAMA. 2002;288(14):1723-172712365955PubMedGoogle ScholarCrossref
5.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity.  JAMA. 2005;293(15):1861-186715840860PubMedGoogle ScholarCrossref
6.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults.  N Engl J Med. 1999;341(15):1097-110510511607PubMedGoogle ScholarCrossref
7.
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality.  N Engl J Med. 1998;338(1):1-79414324PubMedGoogle ScholarCrossref
8.
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity.  JAMA. 2003;289(2):187-19312517229PubMedGoogle ScholarCrossref
9.
Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery.  Lancet. 2003;361(9374):2032-203512814714PubMedGoogle ScholarCrossref
10.
Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients.  Am Surg. 1995;61(11):1001-10057486411PubMedGoogle Scholar
11.
Thomas EJ, Goldman L, Mangione CM,  et al.  Body mass index as a correlate of postoperative complications and resource utilization.  Am J Med. 1997;102(3):277-2839217597PubMedGoogle ScholarCrossref
12.
Birkmeyer NJ, Charlesworth DC, Hernandez F,  et al; Northern New England Cardiovascular Disease Study Group.  Obesity and risk of adverse outcomes associated with coronary artery bypass surgery.  Circulation. 1998;97(17):1689-16949591762PubMedGoogle Scholar
13.
Kamoun S, Alves A, Bretagnol F, Lefevre JH, Valleur P, Panis Y. Outcomes of laparoscopic colorectal surgery in obese and nonobese patients: a case-matched study of 180 patients.  Am J Surg. 2009;198(3):450-45519285301PubMedGoogle ScholarCrossref
14.
Schwandner O, Farke S, Schiedeck THK, Bruch HP. Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes?  Surg Endosc. 2004;18(10):1452-145615791368PubMedGoogle ScholarCrossref
15.
Benns M, Woodall C, Scoggins C, McMasters K, Martin R. The impact of obesity on outcomes following pancreatectomy for malignancy.  Ann Surg Oncol. 2009;16(9):2565-256919557479PubMedGoogle ScholarCrossref
16.
Noun R, Riachy E, Ghorra C,  et al.  The impact of obesity on surgical outcome after pancreaticoduodenectomy.  JOP. 2008;9(4):468-47618648138PubMedGoogle Scholar
17.
Foley K, Lee RB. Surgical complications of obese patients with endometrial carcinoma.  Gynecol Oncol. 1990;39(2):171-1742227591PubMedGoogle ScholarCrossref
18.
Kushnir L, Dunnican WJ, Benedetto B,  et al.  Is BMI greater than 60 kg/m(2) a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass?  Surg Endosc. 2010;24(1):94-9719533240PubMedGoogle ScholarCrossref
19.
Tichansky DS, DeMaria EJ, Fernandez AZ,  et al.  Postoperative complications are not increased in super-super obese patients who undergo laparoscopic Roux-en-Y gastric bypass.  Surg Endosc. 2005;19(7):939-94115920681PubMedGoogle ScholarCrossref
20.
Holley JL, Shapiro R, Lopatin WB, Tzakis AG, Hakala TR, Starzl TE. Obesity as a risk factor following cadaveric renal transplantation.  Transplantation. 1990;49(2):387-3892305469PubMedGoogle ScholarCrossref
21.
Yamamoto S, Hanley E, Hahn AB,  et al.  The impact of obesity in renal transplantation: an analysis of paired cadaver kidneys.  Clin Transplant. 2002;16(4):252-25612099980PubMedGoogle ScholarCrossref
22.
Modlin CS, Flechner SM, Goormastic M,  et al.  Should obese patients lose weight before receiving a kidney transplant?  Transplantation. 1997;64(4):599-6049293872PubMedGoogle ScholarCrossref
23.
Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection.  Am J Surg. 2000;179(4):275-28110875985PubMedGoogle ScholarCrossref
24.
Wagner BD, Grunwald GK, Rumsfeld JS,  et al.  Relationship of body mass index with outcomes after coronary artery bypass graft surgery.  Ann Thorac Surg. 2007;84(1):10-1617588373PubMedGoogle ScholarCrossref
25.
Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery.  J Am Coll Cardiol. 2003;42(4):668-67612932599PubMedGoogle ScholarCrossref
26.
Engelman DT, Adams DH, Byrne JG,  et al.  Impact of body mass index and albumin on morbidity and mortality after cardiac surgery.  J Thorac Cardiovasc Surg. 1999;118(5):866-87310534692PubMedGoogle ScholarCrossref
27.
Mullen JT, Davenport DL, Hutter MM,  et al.  Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery.  Ann Surg Oncol. 2008;15(8):2164-217218548313PubMedGoogle ScholarCrossref
28.
Gurm HS, Brennan DM, Booth J, Tcheng JE, Lincoff AM, Topol EJ. Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox).  Am J Cardiol. 2002;90(1):42-4512088778PubMedGoogle ScholarCrossref
29.
 American College of Surgeons National Surgical Quality Improvement Program. User guide for the 2007 participant use data file. American College of Surgeons Web site. http://acsnsqip.org. Accessed October 5, 2011.
30.
Khuri SF, Henderson WG, Daley J,  et al; Principal Site Investigators of the Patient Safety in Surgery Study.  The patient safety in surgery study: background, study design, and patient populations.  J Am Coll Surg. 2007;204(6):1089-110217544068PubMedGoogle ScholarCrossref
31.
Fink AS, Hutter MM, Campbell DC Jr, Henderson WG, Mosca C, Khuri SF. Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: general surgical operations in women.  J Am Coll Surg. 2007;204(6):1127-113617544071PubMedGoogle ScholarCrossref
32.
Henderson WG, Khuri SF, Mosca C, Fink AS, Hutter MM, Neumayer LA. Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: general surgical operations in men.  J Am Coll Surg. 2007;204(6):1103-111417544069PubMedGoogle ScholarCrossref
33.
Hutter MM, Lancaster RT, Henderson WG,  et al.  Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: vascular surgical operations in men.  J Am Coll Surg. 2007;204(6):1115-112617544070PubMedGoogle ScholarCrossref
34.
Johnson RG, Wittgen CM, Hutter MM, Henderson WG, Mosca C, Khuri SF. Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: vascular surgical operations in women.  J Am Coll Surg. 2007;204(6):1137-114617544072PubMedGoogle ScholarCrossref
35.
 Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health. NIH publication 98-4083. http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Published September 1998. Accessed October 5, 2011
36.
 Clinical Classifications Software (CCS) for ICD-9-CM. Downloading information. Agency for Healthcare Research and Quality Web site. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed October 5, 2011
37.
Hawn MT, Bian J, Leeth RR,  et al.  Impact of obesity on resource utilization for general surgical procedures.  Ann Surg. 2005;241(5):821-826, discussion 826-82815849518PubMedGoogle ScholarCrossref
Original Article
Mar 2012

The Relationship Between Body Mass Index and 30-Day Mortality Risk, by Principal Surgical Procedure

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Turrentine, Hanks, and Schirmer) and Public Health Sciences (Dr Stukenborg), University of Virginia, Charlottesville.

Arch Surg. 2012;147(3):236-242. doi:10.1001/archsurg.2011.310
Abstract

Objective To examine the relationship between body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and 30-day mortality risk among patients in the participant use data file database of the American College of Surgeons National Surgical Quality Improvement Program. Obesity is a prevalent chronic disease in the United States, and general and vascular surgeons are caring for an increasing population of obese patients.

Design Multivariable logistic regression analysis was used to assess the statistical significance of the relationship between BMI and mortality, with adjustments for patient-level differences in overall mortality risk and principal operating procedures. Odds ratios with 95% CIs were calculated to measure the relative difference in mortality by BMI quintile, with reference to the middle quintile of the BMI. The overall significance of the BMI and of the other covariates was measured using the Wald χ2 test statistic. A separate multivariable logistic regression model was developed to assess the significance of the interaction between BMI and primary procedure.

Setting A total of 183 sites.

Patients Patients with major surgical procedures reported in the participant use data file database of the American College of Surgeons National Surgical Quality Improvement Program.

Results The data included 189 533 cases of general and vascular surgical procedures reported in 2005 and 2006 for patients with known overall probabilities of death. Among these, 3245 patients died within 30 days of their surgery (1.7%). Patients with a BMI of less than 23.1 demonstrated a significant increased risk of death, with 40% higher odds compared with patients in the middle range for BMI (26.3 to <29.7). Important differences in the association between BMI and mortality risk occur by type of primary procedure.

Conclusions Body mass index is a significant predictor of mortality within 30 days of surgery, even after adjusting for the contribution to mortality risk made by type of surgery and for a specific patient's overall expected risk of death.

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