title: The impact of high body mass index on postoperative complications and resource utilization in minority patients.
abstract: BACKGROUND
  Obesity is disproportionately prevalent among minority patients, yet very little has been written about its effect on surgical outcome in this group.
  
  
  OBJECTIVE
  We investigated the association of body mass index (BMI) category with perioperative complications and resource utilization.
  
  
  METHODS
  Data from the American College of Surgeons National Surgical Quality improvement Program Participant Use Data File was used to calculate the BMI (kg/m2) of all minority patients undergoing inpatient surgery from 2005 to 2008. Patients were stratified into 4 BMI classes, ranging from normal weight to severely obese. Postoperative length of stay (LOS) was used as the main proxy for resource utilization. Stepwise logistic regression was used to calculate odds ratios for prolonged LOS after controlling for clinically relevant cofactors.
  
  
  RESULTS
  Among 73978 patients, 28% were in the normal BMI category, 28.9% were overweight, 28.2% were obese, and 14.9% were severely obese. Morbidity and mortality distribution varied significantly by BMI category, with the highest proportion of cases occurring in the normal-BMI group and the lowest in the severely obese patients. Postoperative LOS was longer for patients in the normal-BMI group than for severely obese patients. Other markers of resource utilization also followed the same pattern with progressive decrease from normal-BMI patients to the severely obese group.
  
  
  CONCLUSIONS
  Postoperative morbidity and mortality and markers of hospital resource consumption were highest in the normal-BMI patients and decreased progressively to the severely obese group. This group appears to enjoy a paradoxical protection from perioperative complications and so utilize fewer hospital resources.
authors.affiliation: Department of Anesthesiology, University of Michigan, 1500 E Medical Centre Dr, University of Michigan Health System, Room UH 1H247, Ann Arbor, Michigan 48109-0048, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Shanks
authors.forename: Awori J
authors.initials: AJ
authors.lastname: Hayanga
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Tremper
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D050177:Overweight / Q000453:epidemiology* / Q000208:ethnology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology