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Post-colectomy complications more frequent in obese patients

Reuters Health • The Doctor's Channel Daily Newscast

By Will Boggs, MD

NEW YORK (Reuters Health) – Morbidly obese patients face higher complication rates than do normal-weight patients after undergoing surgery for colon cancer, according to a report in the January issue of the Journal of the American College of Surgeons.

“Physicians should be mindful of these complications when caring for morbidly obese patients undergoing colectomy for cancer, and they should consider making appropriate adjustments in their practice to decrease these often devastating complications,” Dr. Ryan P. Merkow told Reuters Health.

Dr. Merkow from the University of Colorado Denver School of Medicine in Aurora, Colorado and colleagues assessed the association of body mass index (BMI) with short-term outcomes after colectomy for cancer in 3,200 patients.

While overweight and obese patients had a significantly higher likelihood of experiencing superficial wound infections and pulmonary embolism than normal-weight patients, the highest risk of complications was in morbidly obese patients — those with a BMI of 35 or greater.

Specifically, morbidly obese patients were significantly more likely than were normal-weight patients to develop superficial or deep surgical site infections (odds ratio 2.66), wound dehiscence (OR 3.51), pulmonary embolism (OR 6.98), and renal failure (OR 2.75), the investigators report.

Overall, the odds ratio for any complication was 1.75 in morbidly obese patients and 1.29 in overweight patients, compared with normal-weight patients.

In contrast, the investigators say, BMI had no significant impact on mortality in the 30 days after surgery.

“The main findings of this study suggest that obesity, in particular morbid obesity, is associated with an increased risk of renal failure, pulmonary embolism, surgical site infections including wound dehiscence, and overall morbidity after colectomy for cancer compared to normal weight patients,” Dr. Merkow concluded. “We believe, in this subset of patients, quality improvement initiatives should focus on these particular complications.”

J Am Coll Surg 2009;208:53-61.