title: Impact of obesity on postoperative and long-term outcomes in a general surgery population: a retrospective cohort study.
abstract: BACKGROUND
  The obesity paradox has been demonstrated postoperatively in several surgical populations, but only a few studies have reported long-term survival. This study evaluates the presence of the obesity paradox in a general surgery population, reporting both postoperative and long-term survival.
  
  
  METHODS
  This retrospective study included 10,427 patients scheduled for elective, noncardiac surgery. Patients were classified as underweight (body mass index (BMI) < 18.5 kg/m(2)); normal weight (BMI 18.5-24.9 kg/m(2)); overweight (BMI 25.0-29.9 kg/m(2)); obesity class I (BMI 30.0-34.9 kg/m(2)); obesity class II (BMI 35.0-39.9 kg/m(2)); and obesity class III (BMI ≥ 40.0 kg/m(2)). Study endpoints were 30-day postoperative and long-term mortality, including cause-specific mortality. Multivariable analyses were used to evaluate mortality risks for each BMI category.
  
  
  RESULTS
  Within 30 days after surgery, 353 (3.4 %) patients died. Overweight was the only category associated with postoperative mortality, showing improved survival [odds ratio 0.7; 95 % confidence interval (CI) 0.6-0.9]. During the long-term follow-up 4,884 (47 %) patients died. Underweight patients had the highest mortality risk [hazard ratio (HR) 1.4; 95 % CI 1.2-1.6), particularly due to high cancer-related deaths. In contrast, overweight and obese patients demonstrated improved survival (overweight: HR 0.8, 95 % CI 0.8-0.9; obesity class I: HR 0.7, 95 % CI 0.7-0.8; obesity class II: HR 0.7, 95 % CI 0.6-0.9; obesity class III: HR 0.7, 95 % CI 0.5-1.0), mainly because of a strongly reduced risk of cancer-related death.
  
  
  CONCLUSIONS
  In this surgical population the obesity paradox was validated at the long term, mainly because of decreased cancer-related deaths among obese patients.
authors.affiliation: Department of Anesthesiology, Erasmus University Medical Center, Room H-1273, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Tabita M
authors.initials: TM
authors.lastname: Valentijn
authors.forename: Wael
authors.initials: W
authors.lastname: Galal
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Yvette R
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Hence J
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stolker
mesh_terms: D015992:Body Mass Index; D005260:Female; D013502:General Surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome