title: Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery.
abstract: BACKGROUND
  Obese patients may face higher complication rates during surgical treatment of colon cancer. The aim of this study was to measure this effect at a high-volume tertiary care center.
  
  
  METHODS
  All patients with colon cancer treated surgically at a single center from 2004 through 2011 were reviewed. Multivariate regression assessed relationships of complications and stay outcomes with body mass index (BMI) controlling for age, gender, comorbidity score, surgical approach, and history of smoking.
  
  
  RESULTS
  In 1,048 included patients, BMI was a predictor of several complications in both laparoscopic and open procedures. For every increase of BMI by one World Health Organization category, the odds ratios were 1.61 (P < .001) for wound infection and 1.54 (P < .001) for slow healing. Additionally, right colectomies had an odds ratio of 3.23 (P = .017) for wound dehiscence. No further associations with BMI were found.
  
  
  CONCLUSIONS
  BMI was incrementally associated with wound-related complications, illustrating how the proliferation of obesity relates to a growing risk for surgical complications. As the surgical community strives to improve the quality of care, patient-controllable factors will play an increasingly important role in cost containment and quality improvement.
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Amri
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: berger.david@mgh.harvard.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001900:Boston / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Body mass index; Colon cancer; Obesity; Perioperative outcomes; Postoperative complications