obesity, outcomes and quality of care: bmi increases the risk of wound-related complications in...
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Obesity, Outcomes and Quality of Care:BMI Increases the Risk of Wound-Related Complications in Colon Cancer Surgery
Ramzi AmriDepartment of General and Gastrointestinal SurgeryHarvard Medical School & Massachusetts General Hospital
8th Academic Surgical CongressFebruary 5-7 2013, New Orleans, LA
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Introduction
•The US continues to struggle with obesity
•Obesity is linked with colon cancer risk
•Obesity is an important surgical risk factor
•SCIP/NSQIP implemented at MGH for > 10 y
Current impact of BMI on complications after
colon cancer surgery?
ASC Quickshot 55.6: Amri et al. February 7th 2013
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Methods
• MGH colon cancer surgeries (all: 2004-2011)
• BMI at surgery in WHO categories
(6: Underweight – Obese III)
• All major postop complications
• Multivariate logistic regression
(p-value, Odds Ratio, 95% CI)
ASC Quickshot 55.6: Amri et al.February 7th 2013
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Results
• N=1071• Most complications NS• Except wound-related:
– Lap and open surgery
– Also in elective surgery
• Corrected for:– Age
– Gender
– ASA score
– Smoking
• Forest plot(all evaluated complications)
ASC Quickshot 55.6: Amri et al.February 7th 2013
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ASC Quickshot 55.6: Amri et al.February 7th 2013
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ASC Quickshot 55.6: Amri et al.February 7th 2013
*
*P <0.001
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Definitions
• Wound infection:
Culture-ascertained infection of the operative wound, or clinically ascertained case severe enough to necessitate antibiotic treatment.
• Slow healing:
Issue in the operative wound needing targeted intervention, but not necessarily of infectious origin.
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Summary
• Wound-related complications linked with BMI
• Odds increase per higher weight category
• Despite SCIP compliance
• SSI focus
• Outside of the control of the surgeon
• Challenge to the surgical communityASC Quickshot 55.6: Amri et al. February 7th 2013
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• Open and Lap: lap no effect on SSI rates:
Weight is a predictor strong enough to be independent of approach.