title: The Effect of Body Mass Index on Perioperative Outcomes After Major Surgery: Results from the National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2011.
abstract: BACKGROUND
  Obesity is associated with poor surgical outcomes and disparity in access-to-care. There is a lack of quality data on the effect of body mass index (BMI) on perioperative outcomes. Accordingly, we sought to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing major surgery.
  
  
  METHODS
  Participants included individuals undergoing one of 16 major surgery (cardiovascular, orthopedic, oncologic; n = 141,802) recorded in the ACS-NSQIP (2005-2011). Outcomes evaluated included complications, blood transfusion, length-of-stay (LOS), re-intervention, readmission, and perioperative mortality. Multivariable-regression models assessed the independent-effect of BMI on outcomes.
  
  
  RESULTS
  Nearly, 74 % of patients had a BMI disturbance; the majority being overweight (35.3 %) or obese (29.8 %). Morbidly obese patients constituted a small but significant proportion of the patients (5.7 %; n = 8067). In adjusted-analyses, morbidly obese patients had significantly increased odds of wound complications in 15 of the examined procedures, of renal complications after 6-procedures, of thromboembolism after 5-procedures, of pulmonary, septic and UTI complications after 2-procedures, and of cardiovascular complications after CABG. Conversely, obese/overweight patients, except for increased odds of wound complications after select procedures, had significantly decreased odds of perioperative mortality, prolonged-LOS and blood transfusion relative to normal BMI patients after 4, 8, and 9 of the examined procedures.
  
  
  CONCLUSIONS
  The prevalence of BMI derangements in surgical patients is high. The effect of BMI on outcomes is procedure specific. Patients with BMI between 18.5 and 40-kg/m(2) at time of surgery fare equally well with regard to complications and mortality. However, morbidly obese patients are at-risk for postsurgical complications and targeted preoperative-optimization may improve outcomes and attenuate disparity in access-to-care.
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Kaustav
authors.initials: K
authors.lastname: Majumder
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mark A
authors.initials: MA
authors.lastname: Preston
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology; D050177:Overweight / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology