TY - JOUR
T1 - Morbid obesity and diverticulitis
T2 - Results from the ACS Nsqip dataset
AU - Bailey, Matthew B.
AU - Davenport, Daniel L.
AU - Procter, Levi
AU - McKenzie, Shaun
AU - Vargas, H. David
PY - 2013/11
Y1 - 2013/11
N2 - Background We examined the relationship between morbid obesity, clinical presentation, and perioperative outcomes in patients offered surgery for diverticulitis. Study Design We queried the ACS NSQIP dataset from 2005 to 2010 for patients undergoing surgery for nonhemorrhaging diverticulitis. Univariate comparisons were made between normal weight (NL) and morbidly obese (MO) patients in terms of demographics, clinical presentation, and perioperative and postoperative outcomes variables using chi-square or rank tests. Multivariable regression was used to adjust for age in assessing the impact of MO on the likelihood of emergent surgery (ES), ostomy creation, open surgery, and undergoing procedures without an anastomosis. Results We identified 10,952 patients undergoing surgery for diverticulitis; morbidly obese (body mass index [BMI] ≥ 40 kg/m2, n = 592, 5.7%), normal weight (BMI 18.5 to 25 kg/m2, n = 2,530, 24.2%). Morbidly obese patients were younger than NL patients by an average of 9.4 years (p < 0.001). Morbidly obese patients underwent ES more frequently than NL patients (19.3% vs 15.4%; p = 0.025). Multivariable regression identified morbid obesity as an independent risk factor for ES (odds ratio [OR] 1.75, 95% CI 1.37 to 2.24, p < 0.001), ostomy creation (OR 1.67, 95% CI 1.34 to 2.08, p < 0.001), undergoing procedures without an anastomosis (OR 1.78, 95% CI 1.42 to 2.24, p < 0.001), and open surgery (OR 2.09, 95% CI 1.72 to 2.53, p < 0.001). Morbidly obese patients undergoing ES had more preoperative systemic inflammatory response syndrome/sepsis/septic shock than NL patients (72.8% vs 57.7%, p = 0.004). Conclusions Morbidly obese patients undergoing surgery for diverticulitis are nearly 10 years younger than NL patients and are more likely to require ES, ostomy creation, open surgery, and to undergo procedures without an anastomosis. Morbidly obese patients undergoing ES also have more preoperative systemic inflammatory response syndrome/sepsis/septic shock.
AB - Background We examined the relationship between morbid obesity, clinical presentation, and perioperative outcomes in patients offered surgery for diverticulitis. Study Design We queried the ACS NSQIP dataset from 2005 to 2010 for patients undergoing surgery for nonhemorrhaging diverticulitis. Univariate comparisons were made between normal weight (NL) and morbidly obese (MO) patients in terms of demographics, clinical presentation, and perioperative and postoperative outcomes variables using chi-square or rank tests. Multivariable regression was used to adjust for age in assessing the impact of MO on the likelihood of emergent surgery (ES), ostomy creation, open surgery, and undergoing procedures without an anastomosis. Results We identified 10,952 patients undergoing surgery for diverticulitis; morbidly obese (body mass index [BMI] ≥ 40 kg/m2, n = 592, 5.7%), normal weight (BMI 18.5 to 25 kg/m2, n = 2,530, 24.2%). Morbidly obese patients were younger than NL patients by an average of 9.4 years (p < 0.001). Morbidly obese patients underwent ES more frequently than NL patients (19.3% vs 15.4%; p = 0.025). Multivariable regression identified morbid obesity as an independent risk factor for ES (odds ratio [OR] 1.75, 95% CI 1.37 to 2.24, p < 0.001), ostomy creation (OR 1.67, 95% CI 1.34 to 2.08, p < 0.001), undergoing procedures without an anastomosis (OR 1.78, 95% CI 1.42 to 2.24, p < 0.001), and open surgery (OR 2.09, 95% CI 1.72 to 2.53, p < 0.001). Morbidly obese patients undergoing ES had more preoperative systemic inflammatory response syndrome/sepsis/septic shock than NL patients (72.8% vs 57.7%, p = 0.004). Conclusions Morbidly obese patients undergoing surgery for diverticulitis are nearly 10 years younger than NL patients and are more likely to require ES, ostomy creation, open surgery, and to undergo procedures without an anastomosis. Morbidly obese patients undergoing ES also have more preoperative systemic inflammatory response syndrome/sepsis/septic shock.
KW - Abbreviations and Acronyms
KW - BMI
KW - ES
KW - MO
KW - NL
KW - OR
KW - PWAN
KW - ROR
KW - SIRS
KW - body mass index
KW - emergent surgery
KW - morbidly obese
KW - normal weight
KW - odds ratio
KW - procedures without an anastomosis
KW - return to the operating room
KW - systemic inflammatory response syndrome
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U2 - 10.1016/j.jamcollsurg.2013.07.006
DO - 10.1016/j.jamcollsurg.2013.07.006
M3 - Article
C2 - 24041558
AN - SCOPUS:84887443435
SN - 1072-7515
VL - 217
SP - 874-880.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 5
ER -