Morbidly Obese Have Longer LOS After Emergency Surgery

Beth Skwarecki

June 17, 2015

Morbidly obese patients with a body mass index (BMI) higher than 40 kg/m2 stayed in the hospital longer after emergency surgery than severely obese patients who had a BMI of 35 kg/m2 or higher in a retrospective, single-center study of 111 obese adults.

"We speculate that these differences would be further magnified in comparison to patients with a healthy BMI," Suzana Küpper, MD, from the Division of General Surgery at the University of Alberta and colleagues write in the Canadian Journal of Surgery, in which the report was published in the February issue.

The rates of complications among these severely and morbidly obese patients were high, with 42% experiencing some type of postsurgical complication. This included 40% who required critical care after surgery, 31% who required reoperation, and 17% who died in the hospital. These rates are higher than previous studies had found in mixed-BMI populations.

Dr Küpper and colleagues analyzed data from a retrospective chart review of obese adults (aged 18 years or older) admitted to the acute care emergency surgery service at the University of Alberta between January 2009 and December 2011. They included 61 patients with a BMI between 35 and 39.9 kg/m2 and 50 patients with a BMI of 40 kg/m2 or greater. The operations included exploratory laparotomy (35%), cholecystectomy (21%), incision and debridement (16%), appendectomy (14%), herniorrhaphy (13%), and other (1%).

Morbidly obese patients had a median 14.5-day (interquartile range, 6 - 39 days) hospital stay after surgery compared with only 6 days (interquartile range, 3 - 15.5 days) for the severely obese (P = .009). The researchers found no other significant differences between the morbidly and severely obese groups in this study, including rates of interoperative complications, reoperation rates, length of stay in intensive care, or mortality, either in-hospital or at 30 days.

In-hospital mortality was higher with increasing age and in patients with preoperative intensive care stays, but BMI was not a factor.

The authors have disclosed no relevant financial relationships.

Can J Surg. 2015;58:41-47. Full text

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