Obesity, Outcomes and Quality of Care:BMI Increases the Risk of Wound-Related Complications in Colon Cancer Surgery

Ramzi AmriDepartment of General and Gastrointestinal SurgeryHarvard Medical School & Massachusetts General Hospital

8th Academic Surgical CongressFebruary 5-7 2013, New Orleans, LA

Introduction

•The US continues to struggle with obesity

•Obesity is linked with colon cancer risk

•Obesity is an important surgical risk factor

•SCIP/NSQIP implemented at MGH for > 10 y

Current impact of BMI on complications after

colon cancer surgery?

ASC Quickshot 55.6: Amri et al. February 7th 2013

Methods

• MGH colon cancer surgeries (all: 2004-2011)

• BMI at surgery in WHO categories

(6: Underweight – Obese III)

• All major postop complications

• Multivariate logistic regression

(p-value, Odds Ratio, 95% CI)

ASC Quickshot 55.6: Amri et al.February 7th 2013

Results

• N=1071• Most complications NS• Except wound-related:

– Lap and open surgery

– Also in elective surgery

• Corrected for:– Age

– Gender

– ASA score

– Smoking

• Forest plot(all evaluated complications)

ASC Quickshot 55.6: Amri et al.February 7th 2013

ASC Quickshot 55.6: Amri et al.February 7th 2013

ASC Quickshot 55.6: Amri et al.February 7th 2013

*

*P <0.001

Definitions

• Wound infection:

Culture-ascertained infection of the operative wound, or clinically ascertained case severe enough to necessitate antibiotic treatment.

• Slow healing:

Issue in the operative wound needing targeted intervention, but not necessarily of infectious origin.

Summary

• Wound-related complications linked with BMI

• Odds increase per higher weight category

• Despite SCIP compliance

• SSI focus

• Outside of the control of the surgeon

• Challenge to the surgical communityASC Quickshot 55.6: Amri et al. February 7th 2013

• Open and Lap: lap no effect on SSI rates:

Weight is a predictor strong enough to be independent of approach.