Postop Death Rate No Higher in Obese Ca Patients

CHICAGO — Obesity was not a risk factor for postoperative mortality or major complications in patients undergoing major intra-abdominal cancer surgery, according to data from a prospective, multicenter risk-adjusted cohort study of 2,258 patients.

As observed in previous studies, however, obesity was a risk factor for minor complications, primarily wound infections.

Importantly, patients who were underweight had a fivefold increased risk of postoperative death, perhaps as a consequence of their underlying poor nutritional status or impaired immunity, investigator Dr. John T. Mullen reported at a symposium sponsored by the Society of Surgical Oncology.

“The prejudice that overweight and obese patients are at increased risk for serious adverse outcomes after major cancer surgery is not justified,” he said. “Paradoxically, overweight status and mild obesity status may be protective of low mortality.”

This possible “obesity paradox” warrants further study, whereas underweight patients might benefit from perioperative nutritional supplementation to mitigate their increased risk of mortality, Dr. Mullen, a surgical oncologist at Beth Israel Deaconess Medical Center, Boston, and his associates concluded.

Underweight patients in the study were significantly more likely to have lost more than 10% of their body weight in the 6 months prior to surgery and to have a lower mean preoperative serum albumin level than other patients have.

Using National Institutes of Health-defined body mass index (BMI) classes, 55 patients were stratified as underweight (BMI up to 18.5 kg/m

Patients underwent the following surgeries from October 2001 to September 2004 at hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program: 29 esophagectomy, 223 gastrectomy, 554 hepatectomy, 699 pancreatectomy, and 753 low anterior resection/proctectomy.

The risk of postoperative death was greatest at the extremes of BMI class, with a 30-day mortality rate of 9% among underweight patients, 2% among normal weight, 2.1% among overweight, 0.84% among obese I, 0.73% among obese II, and 3.8% among obese III, Dr. Mullen said.

In a multivariate analysis that examined 97 variables, the risk of postoperative death was significantly higher for underweight patients, with an odds ratio of 5.24, compared with patients stratified as normal (OR 1.00), overweight (OR 1.06), obese I (OR 0.61), obese II (OR 0.45), and obese III (OR 1.67).

The 30-day morbidity rate was 22% (OR 0.94), 23% (OR 1.00), 26% (OR 1.22), 29% (OR 1.42), 30% (OR 1.42), and 33% (OR 1.50), respectively, Dr. Mullen said.

There was a progressive and significant increase in minor complications, which included only urinary tract and wound infections, with increasing BMI class: underweight 9%, normal weight 13%, overweight 14%, obese I 17%, obese II 18%, and obese III 25%, said Dr. Mullen, who received no funding for the study and reported no conflicts of interest.

There were no differences among the BMI classes in total operative time or number of patients returning to the operating room.

Obesity has long been considered a potential risk factor for poor surgical outcomes, yet the published data are conflicting, Dr. Mullen said. The few studies that have examined outcomes after major cancer surgery have shown only an increased incidence of intra-abdominal and superficial wound infections. They were limited, however, by small numbers, retrospective design, limited patient follow-up, heterogeneity, and types of procedures studied, he said.

CHICAGO — Obesity was not a risk factor for postoperative mortality or major complications in patients undergoing major intra-abdominal cancer surgery, according to data from a prospective, multicenter risk-adjusted cohort study of 2,258 patients.

As observed in previous studies, however, obesity was a risk factor for minor complications, primarily wound infections.

Importantly, patients who were underweight had a fivefold increased risk of postoperative death, perhaps as a consequence of their underlying poor nutritional status or impaired immunity, investigator Dr. John T. Mullen reported at a symposium sponsored by the Society of Surgical Oncology.

“The prejudice that overweight and obese patients are at increased risk for serious adverse outcomes after major cancer surgery is not justified,” he said. “Paradoxically, overweight status and mild obesity status may be protective of low mortality.”

This possible “obesity paradox” warrants further study, whereas underweight patients might benefit from perioperative nutritional supplementation to mitigate their increased risk of mortality, Dr. Mullen, a surgical oncologist at Beth Israel Deaconess Medical Center, Boston, and his associates concluded.

Underweight patients in the study were significantly more likely to have lost more than 10% of their body weight in the 6 months prior to surgery and to have a lower mean preoperative serum albumin level than other patients have.

Using National Institutes of Health-defined body mass index (BMI) classes, 55 patients were stratified as underweight (BMI up to 18.5 kg/m

Patients underwent the following surgeries from October 2001 to September 2004 at hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program: 29 esophagectomy, 223 gastrectomy, 554 hepatectomy, 699 pancreatectomy, and 753 low anterior resection/proctectomy.

The risk of postoperative death was greatest at the extremes of BMI class, with a 30-day mortality rate of 9% among underweight patients, 2% among normal weight, 2.1% among overweight, 0.84% among obese I, 0.73% among obese II, and 3.8% among obese III, Dr. Mullen said.

In a multivariate analysis that examined 97 variables, the risk of postoperative death was significantly higher for underweight patients, with an odds ratio of 5.24, compared with patients stratified as normal (OR 1.00), overweight (OR 1.06), obese I (OR 0.61), obese II (OR 0.45), and obese III (OR 1.67).

The 30-day morbidity rate was 22% (OR 0.94), 23% (OR 1.00), 26% (OR 1.22), 29% (OR 1.42), 30% (OR 1.42), and 33% (OR 1.50), respectively, Dr. Mullen said.

There was a progressive and significant increase in minor complications, which included only urinary tract and wound infections, with increasing BMI class: underweight 9%, normal weight 13%, overweight 14%, obese I 17%, obese II 18%, and obese III 25%, said Dr. Mullen, who received no funding for the study and reported no conflicts of interest.

There were no differences among the BMI classes in total operative time or number of patients returning to the operating room.

Obesity has long been considered a potential risk factor for poor surgical outcomes, yet the published data are conflicting, Dr. Mullen said. The few studies that have examined outcomes after major cancer surgery have shown only an increased incidence of intra-abdominal and superficial wound infections. They were limited, however, by small numbers, retrospective design, limited patient follow-up, heterogeneity, and types of procedures studied, he said.

CHICAGO — Obesity was not a risk factor for postoperative mortality or major complications in patients undergoing major intra-abdominal cancer surgery, according to data from a prospective, multicenter risk-adjusted cohort study of 2,258 patients.

As observed in previous studies, however, obesity was a risk factor for minor complications, primarily wound infections.

Importantly, patients who were underweight had a fivefold increased risk of postoperative death, perhaps as a consequence of their underlying poor nutritional status or impaired immunity, investigator Dr. John T. Mullen reported at a symposium sponsored by the Society of Surgical Oncology.

“The prejudice that overweight and obese patients are at increased risk for serious adverse outcomes after major cancer surgery is not justified,” he said. “Paradoxically, overweight status and mild obesity status may be protective of low mortality.”

This possible “obesity paradox” warrants further study, whereas underweight patients might benefit from perioperative nutritional supplementation to mitigate their increased risk of mortality, Dr. Mullen, a surgical oncologist at Beth Israel Deaconess Medical Center, Boston, and his associates concluded.

Underweight patients in the study were significantly more likely to have lost more than 10% of their body weight in the 6 months prior to surgery and to have a lower mean preoperative serum albumin level than other patients have.

Using National Institutes of Health-defined body mass index (BMI) classes, 55 patients were stratified as underweight (BMI up to 18.5 kg/m

Patients underwent the following surgeries from October 2001 to September 2004 at hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program: 29 esophagectomy, 223 gastrectomy, 554 hepatectomy, 699 pancreatectomy, and 753 low anterior resection/proctectomy.

The risk of postoperative death was greatest at the extremes of BMI class, with a 30-day mortality rate of 9% among underweight patients, 2% among normal weight, 2.1% among overweight, 0.84% among obese I, 0.73% among obese II, and 3.8% among obese III, Dr. Mullen said.

In a multivariate analysis that examined 97 variables, the risk of postoperative death was significantly higher for underweight patients, with an odds ratio of 5.24, compared with patients stratified as normal (OR 1.00), overweight (OR 1.06), obese I (OR 0.61), obese II (OR 0.45), and obese III (OR 1.67).

The 30-day morbidity rate was 22% (OR 0.94), 23% (OR 1.00), 26% (OR 1.22), 29% (OR 1.42), 30% (OR 1.42), and 33% (OR 1.50), respectively, Dr. Mullen said.

There was a progressive and significant increase in minor complications, which included only urinary tract and wound infections, with increasing BMI class: underweight 9%, normal weight 13%, overweight 14%, obese I 17%, obese II 18%, and obese III 25%, said Dr. Mullen, who received no funding for the study and reported no conflicts of interest.

There were no differences among the BMI classes in total operative time or number of patients returning to the operating room.

Obesity has long been considered a potential risk factor for poor surgical outcomes, yet the published data are conflicting, Dr. Mullen said. The few studies that have examined outcomes after major cancer surgery have shown only an increased incidence of intra-abdominal and superficial wound infections. They were limited, however, by small numbers, retrospective design, limited patient follow-up, heterogeneity, and types of procedures studied, he said.