Impact of Body Mass Index on Outcomes After Breast Cancer Surgery: Nationwide Inpatient Database Study in Japan |
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| Institution: | 1. Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan;3. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;4. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan;1. The Department of Cardiovascular Medicine, The University of Tokyo, Japan;2. The Department of Advanced Cardiology, The University of Tokyo, Japan;3. The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan;4. The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan;5. The Department of Health Services Research, The University of Tokyo, Japan;1. Department of Information Technology and Management, The National Center of Child Health and Development, Japan;2. Children''s Cancer Center, The National Center of Child Health and Development, Japan;3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA;4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan;1. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan;2. Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Japan;3. Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan;4. Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Japan;1. Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan;2. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA;3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan;4. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. Office for Infectious Control, National Center for Child Health and Development, Tokyo, Japan;6. Graduate School of Public Health, St Luke’s International University, Tokyo, Japan;1. Department of Health Services Research, Graduate School of Medicine, Japan;2. Department of Respiratory Medicine, Graduate School of Medicine, Japan;3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan;4. Data Science Center, Jichi Medical University, Tochigi, Japan;5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan |
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| Abstract: | BackgroundRecent studies have shown better postoperative outcomes in mildly obese patients, a phenomenon called the obesity paradox. In the field of breast cancer surgery, however, previous studies have only shown an association between obesity and worse postoperative outcomes using multivariable analysis; the obesity paradox has not been investigated in patients undergoing breast cancer surgery.Patients and MethodsWe identified patients who underwent mastectomy for stage 0 to III breast cancer from July 2010 to March 2017 using a Japanese nationwide inpatient database. We used restricted cubic spline analyses to investigate potential nonlinear associations between body mass index (BMI) and outcomes (postoperative complications, 30-day readmission, duration of anesthesia, length of hospital stay, and hospitalization costs). We also performed multivariable regression analyses for the outcomes.ResultsAmong 239,108 eligible patients, 25.6% had a BMI of > 25.0 kg/m2. BMI showed U-shaped associations with postoperative complications, length of stay, and hospitalization costs, and a linear association with duration of anesthesia. The proportion of postoperative complications was lowest at a BMI of around 22.0 kg/m2, while the length of stay was shortest and total costs were lowest at a BMI of around 20.0 kg/m2. Compared to a BMI of 22.0 kg/m2, a BMI of > 30.0 kg/m2 was significantly associated with greater postoperative complications, 30-day readmission, duration of anesthesia, length of stay, and hospitalization costs.ConclusionRestricted cubic spline analyses displayed U-shaped associations between BMI and in-hospital complications, length of stay, and hospitalization costs, but none of the associations showed the obesity paradox. |
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| Keywords: | Breast-conserving surgery Body mass index Mastectomy Obesity paradox Short-term outcome |
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