The impact of obesity on minimally invasive colorectal surgery: A report from the Surgical Care Outcomes Assessment Program collaborative
| Autor: | Amir L. Bastawrous, Jennifer A. Kaplan, Vlad V. Simianu, Ravi Moonka, Kenley R. Unruh, Laila Rashidi |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Colon Operative Time 030230 surgery Logistic regression Body Mass Index Colonic Diseases 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Minimally Invasive Surgical Procedures Obesity Adverse effect Colectomy Aged Retrospective Studies business.industry Surgical care Rectum Retrospective cohort study Mean age General Medicine Middle Aged Risk adjustment medicine.disease Conversion to Open Surgery Colorectal surgery Rectal Diseases Treatment Outcome 030220 oncology & carcinogenesis Female Surgery business |
| Zdroj: | The American Journal of Surgery. 221:1211-1220 |
| ISSN: | 0002-9610 |
| Popis: | 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.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.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).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. |
| Databáze: | OpenAIRE |
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