title: Morbid Obesity is Associated with Increased Mortality, Surgical Complications, and Incremental Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery.
abstract: BACKGROUND
  Morbid obesity (Basic Mass Index ≥ 40 kg/m(2)) leads to increased long-term mortality after colorectal cancer (CRC) surgery. Little is known about its effects on peri-operative CRC surgery outcomes.
  
  
  METHODS
  85,300 discharges for CRC surgery were identified using the redesigned 2012 National Inpatient Sample. Outcomes of interest were mortality, healthcare charges, and surgical outcomes in morbidly obese patients which were compared to those in nonobese patients.
  
  
  RESULTS
  There were 4385 (5.14%) morbidly obese patients who underwent CRC surgery during the study period. Morbid obesity was associated with younger age, females, and African Americans in our study (p < 0.05). Morbidly obese patients had higher prevalence of CRC peri-operative co-morbidities, surgical complications, and conversions from laparoscopic to open surgery. On multivariate analysis, morbid obesity led to an increased CRC surgery peri-operative mortality (OR 1.85, 95 % CI 1.15, 2.97). Mortality remained significant even after adjusting for surgical complications (OR 1.79, 95 % CI 1.12, 2.88). Morbidly obese patients undergoing CRC also had a prolonged length of hospitalization (1.22 day, 95 % CI 0.67, 1.78), a $15,582 increase in total hospital charges (95 % CI 8419, 22,745), and increased disposition to short-term rehabilitation facilities (OR 2.25, 95 % CI 1.79, 2.84).
  
  
  CONCLUSIONS
  Analysis of national level data demonstrates that morbidly obese patients have an increased CRC surgery peri-operative mortality with higher prevalence of co-morbidities, surgical complications, and more health care resource utilization. Future research efforts should concentrate on ameliorating these outcomes in morbidly obese patients.
authors.affiliation: Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, 395 W 12th Ave, Suite 240, Columbus, OH, 43210, USA. hisham.Hussan@osumc.edu.
authors.forename: Hisham
authors.initials: H
authors.lastname: Hussan
authors.affiliation: Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, 395 W 12th Ave, Suite 240, Columbus, OH, 43210, USA.
authors.forename: Darrell M
authors.initials: DM
authors.lastname: Gray
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Hinton
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.affiliation: Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, 395 W 12th Ave, Suite 240, Columbus, OH, 43210, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Stanich
mesh_terms: D000368:Aged; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D017722:Hospital Charges / Q000639:trends; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology