Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry.

Autor: Govaert JA; Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.; Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands., Lijftogt N; Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands., van Dijk WA; Performation, Bilthoven, Utrecht, the Netherlands.; X-IS, Delft, Zuid-Holland, the Netherlands., Tseng LN; Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands.; Dutch Obesity Clinic, Den Haag, Zuid-Holland, the Netherlands., Liem RS; Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands.; Dutch Obesity Clinic, Den Haag, Zuid-Holland, the Netherlands., Tollenaar RA; Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands., Fiocco M; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.; Leiden University Mathematical Institute, Leiden, Zuid-Holland, the Netherlands., Wouters MW; Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.; Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2016 Apr; Vol. 113 (5), pp. 489-95. Date of Electronic Publication: 2016 Feb 04.
DOI: 10.1002/jso.24187
Abstrakt: Background and Objectives: The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution.
Methods: All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used.
Results: Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%).
Conclusions: Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495. © 2016 Wiley Periodicals, Inc.
(© 2016 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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