Karin Hardiman1, Eric T Chang, Brian S Diggs, Kim C Lu. 1. Division of Colorectal Surgery, Department of Surgery, University of Michigan, 2124-H Taubman Center, 1500 E Medical Center Dr, SPC 5343, Ann Arbor, MI 48109, USA. kmha@med.umich.edu
Abstract
BACKGROUND: Obesity is a growing epidemic in the US and increases the difficulty of laparoscopic surgery. Randomized, controlled trials of laparoscopic vs. open colectomy have shown equivalence but often exclude obese patients thus not answering whether obese patients may specifically benefit from laparoscopy. We hypothesized that obese patients would benefit from use of laparoscopy for colectomy. METHODS: We used the National Surgical Quality Improvement Program database from 2005 to 2009 and chose elective laparoscopic and open segmental colectomy and ileocecal resections. We compared patients' demographics, comorbidities, and outcomes. We used multivariate models to assess for predictors of complications in obese patients. These models included demographics, comorbidities, and outcomes. RESULTS: 35,998 patients were identified who underwent elective colectomy with primary anastomosis. Forty-four percent of the included cases were laparoscopic and 31 % of patients had a BMI greater than 30 (obese). Obese patients were more likely to have diabetes, hypertension, prior percutaneous coronary intervention, and dyspnea on exertion. We constructed a new variable called any complication that included all complications except 30-day mortality. In our multivariate analysis, laparoscopic approach in obese patients independently decreased the relative risk of superficial (odds ratio (OR) 0.72, 95 % confidence interval (CI) 0.63-0.82) and deep (OR 0.44, CI 0.31-0.61) surgical site infections, intra-abdominal infection (OR 0.61, CI 0.49-0.78), dehiscence (OR 0.50, CI 0.35-0.69), pneumonia (OR 0.60, CI 0.44-0.81), failure to wean from the ventilator (OR 0.64, CI 0.47-0.87), renal failure (OR 0.58, CI 0.35-0.96), urinary tract infection (OR 0.62, CI 0.49-0.79), sepsis (OR 0.53, CI 0.43-0.66), septic shock (OR 0.65, CI 0.47-0.90), any complication (OR 0.61, CI 0.55-0.67) and 30-day mortality (OR 0.56, CI 0.31-0.98). CONCLUSIONS: Due to the significant decrease in the risk of morbidity and mortality, laparoscopic colectomy should be offered to obese patients whenever feasible.
BACKGROUND: Obesity is a growing epidemic in the US and increases the difficulty of laparoscopic surgery. Randomized, controlled trials of laparoscopic vs. open colectomy have shown equivalence but often exclude obesepatients thus not answering whether obesepatients may specifically benefit from laparoscopy. We hypothesized that obesepatients would benefit from use of laparoscopy for colectomy. METHODS: We used the National Surgical Quality Improvement Program database from 2005 to 2009 and chose elective laparoscopic and open segmental colectomy and ileocecal resections. We compared patients' demographics, comorbidities, and outcomes. We used multivariate models to assess for predictors of complications in obesepatients. These models included demographics, comorbidities, and outcomes. RESULTS: 35,998 patients were identified who underwent elective colectomy with primary anastomosis. Forty-four percent of the included cases were laparoscopic and 31 % of patients had a BMI greater than 30 (obese). Obesepatients were more likely to have diabetes, hypertension, prior percutaneous coronary intervention, and dyspnea on exertion. We constructed a new variable called any complication that included all complications except 30-day mortality. In our multivariate analysis, laparoscopic approach in obesepatients independently decreased the relative risk of superficial (odds ratio (OR) 0.72, 95 % confidence interval (CI) 0.63-0.82) and deep (OR 0.44, CI 0.31-0.61) surgical site infections, intra-abdominal infection (OR 0.61, CI 0.49-0.78), dehiscence (OR 0.50, CI 0.35-0.69), pneumonia (OR 0.60, CI 0.44-0.81), failure to wean from the ventilator (OR 0.64, CI 0.47-0.87), renal failure (OR 0.58, CI 0.35-0.96), urinary tract infection (OR 0.62, CI 0.49-0.79), sepsis (OR 0.53, CI 0.43-0.66), septic shock (OR 0.65, CI 0.47-0.90), any complication (OR 0.61, CI 0.55-0.67) and 30-day mortality (OR 0.56, CI 0.31-0.98). CONCLUSIONS: Due to the significant decrease in the risk of morbidity and mortality, laparoscopic colectomy should be offered to obesepatients whenever feasible.
Authors: Marlin W Causey; Eric K Johnson; Seth Miller; Matthew Martin; Justin Maykel; Scott R Steele Journal: Dis Colon Rectum Date: 2011-12 Impact factor: 4.585
Authors: Mark Buunen; Ruben Veldkamp; Wim C J Hop; Esther Kuhry; Johannes Jeekel; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio Lacy; Hendrik J Bonjer Journal: Lancet Oncol Date: 2008-12-13 Impact factor: 41.316
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: Bradley J Champagne; Madhuri Nishtala; Justin T Brady; Benjamin P Crawshaw; Morris E Franklin; Conor P Delaney; Scott R Steele Journal: Int J Colorectal Dis Date: 2017-07-14 Impact factor: 2.571
Authors: Rachelle N Damle; Christopher W Macomber; Julie M Flahive; Jennifer S Davids; W Brian Sweeney; Paul R Sturrock; Justin A Maykel; Heena P Santry; Karim Alavi Journal: J Am Coll Surg Date: 2014-03-12 Impact factor: 6.113
Authors: Hamza Guend; David Y Lee; Elizabeth A Myers; Nipa D Gandhi; Vesna Cekic; Richard L Whelan Journal: Surg Endosc Date: 2014-12-06 Impact factor: 4.584
Authors: Deborah S Keller; Sergio Ibarra; Juan Ramon Flores-Gonzalez; Oscar Moreno Ponte; Nisreen Madhoun; T Bartley Pickron; Eric M Haas Journal: Surg Endosc Date: 2015-06-20 Impact factor: 4.584
Authors: Deborah S Keller; Nisreen Madhoun; Juan Ramon Flores-Gonzalez; Sergio Ibarra; Reena Tahilramani; Eric M Haas Journal: J Gastrointest Surg Date: 2015-12-24 Impact factor: 3.452