title: Obesity increases wound complications in rectal cancer surgery.
abstract: BACKGROUND
  Obesity increases the risk of wound infections following surgery for colon cancer. Considerably less data is available, however, regarding the impact of obesity on infections and wound complications after resection for rectal cancer. Additionally, the impact of minimally invasive surgery (MIS) on complications in rectal surgery remains unclear. We hypothesized that obesity is associated with prolonged operative time and more infectious complications in obese patients undergoing both MIS and open surgery for rectal cancer.
  
  
  METHODS
  Review of retrospective surgical database.
  
  
  RESULTS
  One hundred fifty patients underwent surgery for rectal cancer from 2002 to 2009. Open cases accounted for 72% (n = 108) and MIS for 28% (n = 42) of cases. BMI did not correlate with increased operative time in open rectal surgery, but in MIS patients, operative time increased from a median of 254 min in the lowest quartile of BMI to 333 min in the highest quartile (P < 0.004). Superficial wound infections in open rectal surgery increased from 17% to 52% with increasing BMI (P < 0.005). The increased rate of wound complications persisted in the MIS group. Rate of superficial wound infections and subsequent open packing in the MIS group increased from 0% in the lowest BMI quartile to 33% in the highest quartile (P < 0.029 and P < 0.007, respectively).
  
  
  CONCLUSIONS
  Elevated BMI is associated with increased wound complications in both minimally invasive and open rectal surgery. This trend may be related to prolonged operative time in obese patients, particularly in MIS. Our observations suggest that more aggressive techniques to prevent infection are warranted in obese patients undergoing rectal surgery.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77057, USA. cb131098@bcm.tmc.edu
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilks
authors.forename: Celia
authors.initials: C
authors.lastname: Robinson
authors.forename: Christy
authors.initials: C
authors.lastname: Marshall
authors.forename: Daniel
authors.initials: D
authors.lastname: Anaya
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009765:Obesity / Q000150:complications*; D012004:Rectal Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D013781:Texas / Q000453:epidemiology