title: Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry.
abstract: OBJECTIVE
  The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution.
  
  
  METHODS
  All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used.
  
  
  RESULTS
  Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%).
  
  
  CONCLUSIONS
  Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495. © 2016 Wiley Periodicals, Inc.
authors: Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.|Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands.
authors: Johannes A
authors: JA
authors: Govaert
authors: Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.
authors: Niki
authors: N
authors: Lijftogt
authors: Performation, Bilthoven, Utrecht, the Netherlands.|X-IS, Delft, Zuid-Holland, the Netherlands.
authors: Wouter A
authors: WA
authors: van Dijk
authors: Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands.|Dutch Obesity Clinic, Den Haag, Zuid-Holland, the Netherlands.
authors: Larissa N L
authors: LN
authors: Tseng
authors: Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands.|Dutch Obesity Clinic, Den Haag, Zuid-Holland, the Netherlands.
authors: Ronald S L
authors: RS
authors: Liem
authors: Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.
authors: Rob A E M
authors: RA
authors: Tollenaar
authors: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.|Leiden University Mathematical Institute, Leiden, Zuid-Holland, the Netherlands.
authors: Marta
authors: M
authors: Fiocco
authors: Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.|Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, the Netherlands.
authors: Michel W J M
authors: MW
authors: Wouters
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002277:Carcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D016896:Treatment Outcome
keywords: colorectal cancer surgery; hospital costs; obesity