title: Laparoscopic colectomy reduces morbidity and mortality in obese patients.
abstract: BACKGROUND
  Obesity is a growing epidemic in the US and increases the difficulty of laparoscopic surgery. Randomized, controlled trials of laparoscopic vs. open colectomy have shown equivalence but often exclude obese patients thus not answering whether obese patients may specifically benefit from laparoscopy. We hypothesized that obese patients would benefit from use of laparoscopy for colectomy.
  
  
  METHODS
  We used the National Surgical Quality Improvement Program database from 2005 to 2009 and chose elective laparoscopic and open segmental colectomy and ileocecal resections. We compared patients' demographics, comorbidities, and outcomes. We used multivariate models to assess for predictors of complications in obese patients. These models included demographics, comorbidities, and outcomes.
  
  
  RESULTS
  35,998 patients were identified who underwent elective colectomy with primary anastomosis. Forty-four percent of the included cases were laparoscopic and 31 % of patients had a BMI greater than 30 (obese). Obese patients were more likely to have diabetes, hypertension, prior percutaneous coronary intervention, and dyspnea on exertion. We constructed a new variable called any complication that included all complications except 30-day mortality. In our multivariate analysis, laparoscopic approach in obese patients independently decreased the relative risk of superficial (odds ratio (OR) 0.72, 95 % confidence interval (CI) 0.63-0.82) and deep (OR 0.44, CI 0.31-0.61) surgical site infections, intra-abdominal infection (OR 0.61, CI 0.49-0.78), dehiscence (OR 0.50, CI 0.35-0.69), pneumonia (OR 0.60, CI 0.44-0.81), failure to wean from the ventilator (OR 0.64, CI 0.47-0.87), renal failure (OR 0.58, CI 0.35-0.96), urinary tract infection (OR 0.62, CI 0.49-0.79), sepsis (OR 0.53, CI 0.43-0.66), septic shock (OR 0.65, CI 0.47-0.90), any complication (OR 0.61, CI 0.55-0.67) and 30-day mortality (OR 0.56, CI 0.31-0.98).
  
  
  CONCLUSIONS
  Due to the significant decrease in the risk of morbidity and mortality, laparoscopic colectomy should be offered to obese patients whenever feasible.
authors: Division of Colorectal Surgery, Department of Surgery, University of Michigan, 2124-H Taubman Center, 1500 E Medical Center Dr, SPC 5343, Ann Arbor, MI 48109, USA. kmha@med.umich.edu
authors: Karin
authors: K
authors: Hardiman
authors: Eric T
authors: ET
authors: Chang
authors: Brian S
authors: BS
authors: Diggs
authors: Kim C
authors: KC
authors: Lu
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009765:Obesity / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology