Motonari Ri1, Hiroaki Miyata2, Susumu Aikou1, Yasuyuki Seto3, Kohei Akazawa4, Masahiro Takeuchi5, Yoshiro Matsui6, Hiroyuki Konno7, Mitsukazu Gotoh7, Masaki Mori7, Noboru Motomura8, Shinichi Takamoto8, Yoshiki Sawa9, Hiroyuki Kuwano10, Norihiro Kokudo11. 1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 2. National Clinical Database (NCD), Tokyo, Japan. 3. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. seto-tky@umin.ac.jp. 4. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan. 5. Department of Clinical Medicine, School of Pharmacy, Kitasato University, Kanagawa, Japan. 6. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. 7. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 8. Japan Cardiovascular Surgery Database Organization, Tokyo, Japan. 9. Department of Cardiovascular Surgery, Osaka University of Medicine, Osaka, Japan. 10. Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan. 11. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Abstract
PURPOSE: To define the effects of body mass index (BMI) on operative outcomes for both gastroenterological and cardiovascular surgery, using the National Clinical Database (NCD) of the Japanese nationwide web-based database. METHODS: The subjects of this study were 288,418 patients who underwent typical surgical procedures between January 2011 and December 2012. There were eight gastroenterological procedures, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy of >1 segment excluding the lateral segment, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis (n = 232,199); and five cardiovascular procedures, including aortic valve replacement, total arch replacement (TAR), descending thoracic aorta replacement (descending TAR), and on- or off-pump coronary artery bypass grafting (n = 56,219). The relationships of BMI with operation time and operative mortality for each procedure were investigated, using the NCD. RESULTS: Operation times were longer for patients with a higher BMI. When a BMI cut-off of 30 was used, the operation time for obese patients was significantly longer than that for non-obese patients, for all procedures except esophagectomy (P < 0.01). The mortality rate based on BMI revealed a U-shaped distribution, with both underweight and obese patients having high mortality rates for almost all procedures. CONCLUSIONS: This Japanese nationwide study provides solid evidence to reinforce that both obesity and excessively low weight are factors that impact operative outcomes significantly.
PURPOSE: To define the effects of body mass index (BMI) on operative outcomes for both gastroenterological and cardiovascular surgery, using the National Clinical Database (NCD) of the Japanese nationwide web-based database. METHODS: The subjects of this study were 288,418 patients who underwent typical surgical procedures between January 2011 and December 2012. There were eight gastroenterological procedures, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy of >1 segment excluding the lateral segment, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis (n = 232,199); and five cardiovascular procedures, including aortic valve replacement, total arch replacement (TAR), descending thoracic aorta replacement (descending TAR), and on- or off-pump coronary artery bypass grafting (n = 56,219). The relationships of BMI with operation time and operative mortality for each procedure were investigated, using the NCD. RESULTS: Operation times were longer for patients with a higher BMI. When a BMI cut-off of 30 was used, the operation time for obesepatients was significantly longer than that for non-obesepatients, for all procedures except esophagectomy (P < 0.01). The mortality rate based on BMI revealed a U-shaped distribution, with both underweight and obesepatients having high mortality rates for almost all procedures. CONCLUSIONS: This Japanese nationwide study provides solid evidence to reinforce that both obesity and excessively low weight are factors that impact operative outcomes significantly.
Entities:
Keywords:
Body mass index; National clinical database; Nationwide web-based database; Operation time; Operative mortality
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