title: Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study.
abstract: BACKGROUND
  The aim of this study was to assess perioperative outcomes in obese patients undergoing emergency surgery.
  
  
  METHODS
  We retrospectively reviewed the charts of all adult (> 17 yr) patients admitted to the acute care emergency surgery service at the University of Alberta Hospital between January 2009 and December 2011 who had a body mass index (BMI) of 35 or higher. Patients were divided into subgroups for analysis based on "severe" (BMI 35-39.9) and "morbid" obesity (BMI ≥ 40). Multivariate logistic regression was performed to identify predictors of in-hospital mortality after controlling for confounding factors.
  
  
  RESULTS
  Data on 111 patients (55% women, median BMI 39) were included in the final analysis. Intensive care unit (ICU) support was required for 40% of patients. Postoperative complications occurred in 42% of patients, and 31% required reoperation. Overall in-hospital mortality was 17%. Morbidly obese patients had increased rates of reoperation (40% v. 23%, p = 0.05) and increased lengths of stay compared with severely obese patients (14.5 v. 6.0 d, p = 0.09). Age (odds ratio [OR] 1.08 per increment) and preoperative ICU stay (OR 12) were significantly associated with in-hospital mortality after controlling for confounding, but BMI was not.
  
  
  CONCLUSIONS
  Obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity and mortality. Greater resources are required for their care, including ICU support, repeat surgery and prolonged ICU stay. Future studies could help identify predictors of reoperation and strategies to optimize nutrition, rehabilitation and resource allocation.
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta.
authors.forename: Suzana
authors.initials: S
authors.lastname: Küpper
authors.affiliation: The Division of Gastroenterology, Department of Medicine and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta.
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.affiliation: The Division of General Surgery, Department of Surgery, and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Khadaroo
authors.affiliation: The Division of General Surgery, Department of Surgery, and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta.
authors.forename: Sandy L
authors.initials: SL
authors.lastname: Widder
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult