Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery: Body mass index and postoperative complications following gastrointestinal surgery

STARSurg Collaborative

doi:10.1002/bjs.10203

Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery: Body mass index and postoperative complications following gastrointestinal surgery

STARSurg Collaborative

Research output: Contribution to journal › Article › peer-review

63 Citations (Scopus)

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Abstract

Background: There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.Methods: This was a multicentre prospective cohort study across the UK and Republic of Ireland.Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4-month interval(October–December 2014) were eligible for inclusion. The primary outcome was the 30-day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital-level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).Results: Of 7965 patients, 2545 (32⋅0 per cent) were of normal weight, 2673 (33⋅6 per cent) were overweight and 2747 (34⋅5 per cent) were obese. Overall, 4925 (61⋅8 per cent) underwent elective and 3038 (38⋅1 per cent) emergency operations. The 30-day major complication rate was 11⋅4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1⋅59, 95 per cent c.i. 1⋅12 to 2⋅29, P = 0⋅008; obese: OR 1⋅91, 1⋅31 to 2⋅83, P = 0⋅002; compared with normal weight) but not benign disease (overweight: OR 0⋅89, 0⋅71 to 1⋅12, P = 0⋅329; obese: OR 0⋅84,0⋅66 to 1⋅06, P = 0⋅147).Conclusion: Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Original language	English
Pages (from-to)	1157-1172
Number of pages	16
Journal	British Journal of Surgery
Volume	103
Issue number	9
Early online date	20 Jun 2016
DOIs	https://doi.org/10.1002/bjs.10203
Publication status	Published - 18 Jul 2016

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SDG 3 Good Health and Well-being

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© 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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@article{24349da4fd054d68a4574bdd833b1603,

title = "Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery: Body mass index and postoperative complications following gastrointestinal surgery",

abstract = "Background: There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.Methods: This was a multicentre prospective cohort study across the UK and Republic of Ireland.Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4-month interval(October–December 2014) were eligible for inclusion. The primary outcome was the 30-day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital-level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).Results: Of 7965 patients, 2545 (32⋅0 per cent) were of normal weight, 2673 (33⋅6 per cent) were overweight and 2747 (34⋅5 per cent) were obese. Overall, 4925 (61⋅8 per cent) underwent elective and 3038 (38⋅1 per cent) emergency operations. The 30-day major complication rate was 11⋅4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1⋅59, 95 per cent c.i. 1⋅12 to 2⋅29, P = 0⋅008; obese: OR 1⋅91, 1⋅31 to 2⋅83, P = 0⋅002; compared with normal weight) but not benign disease (overweight: OR 0⋅89, 0⋅71 to 1⋅12, P = 0⋅329; obese: OR 0⋅84,0⋅66 to 1⋅06, P = 0⋅147).Conclusion: Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.",

author = "\{STARSurg Collaborative\} and Devender Mittapalli and A. Bhangu",

year = "2016",

month = jul,

day = "18",

doi = "10.1002/bjs.10203",

language = "English",

volume = "103",

pages = "1157--1172",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "9",

}

Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery: Body mass index and postoperative complications following gastrointestinal surgery. / STARSurg Collaborative.
In: British Journal of Surgery, Vol. 103, No. 9, 18.07.2016, p. 1157-1172.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery

T2 - Body mass index and postoperative complications following gastrointestinal surgery

AU - STARSurg Collaborative

AU - Mittapalli, Devender

AU - Bhangu, A.

PY - 2016/7/18

Y1 - 2016/7/18

N2 - Background: There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.Methods: This was a multicentre prospective cohort study across the UK and Republic of Ireland.Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4-month interval(October–December 2014) were eligible for inclusion. The primary outcome was the 30-day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital-level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).Results: Of 7965 patients, 2545 (32⋅0 per cent) were of normal weight, 2673 (33⋅6 per cent) were overweight and 2747 (34⋅5 per cent) were obese. Overall, 4925 (61⋅8 per cent) underwent elective and 3038 (38⋅1 per cent) emergency operations. The 30-day major complication rate was 11⋅4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1⋅59, 95 per cent c.i. 1⋅12 to 2⋅29, P = 0⋅008; obese: OR 1⋅91, 1⋅31 to 2⋅83, P = 0⋅002; compared with normal weight) but not benign disease (overweight: OR 0⋅89, 0⋅71 to 1⋅12, P = 0⋅329; obese: OR 0⋅84,0⋅66 to 1⋅06, P = 0⋅147).Conclusion: Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

AB - Background: There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.Methods: This was a multicentre prospective cohort study across the UK and Republic of Ireland.Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4-month interval(October–December 2014) were eligible for inclusion. The primary outcome was the 30-day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital-level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).Results: Of 7965 patients, 2545 (32⋅0 per cent) were of normal weight, 2673 (33⋅6 per cent) were overweight and 2747 (34⋅5 per cent) were obese. Overall, 4925 (61⋅8 per cent) underwent elective and 3038 (38⋅1 per cent) emergency operations. The 30-day major complication rate was 11⋅4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1⋅59, 95 per cent c.i. 1⋅12 to 2⋅29, P = 0⋅008; obese: OR 1⋅91, 1⋅31 to 2⋅83, P = 0⋅002; compared with normal weight) but not benign disease (overweight: OR 0⋅89, 0⋅71 to 1⋅12, P = 0⋅329; obese: OR 0⋅84,0⋅66 to 1⋅06, P = 0⋅147).Conclusion: Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

U2 - 10.1002/bjs.10203

DO - 10.1002/bjs.10203

M3 - Article

C2 - 27321766

SN - 0007-1323

VL - 103

SP - 1157

EP - 1172

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 9

ER -