Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery |
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| Affiliation: | 4. Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan;1. Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China;2. Department of Anesthesiology, Hospital of Integrated Traditional Chinese and Western Medicine of Liangshan Prefecture, Liangshan 615000, Sichuan, China;3. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China;1. Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China;2. Department of Anesthesiology, Yancheng Third People''s Hospital, Yancheng, Jiangsu, China;3. Department of Cardiovascular Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China;4. Department of Anesthesiology, University of Utah Health, Salt Lake City, UT, USA;5. Transitional Residency Program, Intermountain Medical Center, Murray, UT, USA;6. Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA;1. Icahn School of Medicine at Mount Sinai, New York, NY, United States of America;2. Department of Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America;1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China;2. Department of Anesthesiology, People''s Hospital of Sanshui District, Foshan, Guangdong 528100, China;1. Department of Health Sciences, University of Milan, Milan, Italy;2. Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy |
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| Abstract: | Study objectiveTo determine whether obesity status is associated with perioperative complications, discharge outcomes and hospital length of stay in older surgical patients.DesignSecondary analysis of five independent study cohorts (N = 1262).SettingAn academic medical center between 2001 and 2017 in the United States.PatientsPatients aged 65 years or older who were scheduled to undergo elective spine, knee, or hip surgery with an expected hospital stay of at least 2 days.MeasurementsBody mass index (BMI) was stratified as nonobese (BMI ≤ 30 kg/m2), obesity class 1 (30 kg/m2 ≤ BMI < 35 kg/m2) or obesity class 2–3 (BMI ≥ 35 kg/m2). Primary outcomes included predefined intraoperative and postoperative complications, hospital length of stay (LOS), and discharge location. Univariate and multivariate logistic regression was performed.Main resultsObesity status was not associated with intraoperative adverse events. However, obesity class 2–3 significantly increased the risk for postoperative complications (IRR 1.43, 95% CI 1.03–1.95, P = 0.03), hospital LOS (IRR 1.13, 95% CI 1.02–1.25, P = 0.02) and non-home discharge destination (OR 1.95, 95% CI 1.35–2.81, P < 0.001) after accounting for patient related factors and surgery type.ConclusionsObesity class 2–3 status has prognostic value in predicting an increased incidence of postoperative complications, increased hospital LOS, and non-home discharge location. These results have important clinical implications for preoperative informed consent and provide areas to target for care improvement for the older obese individual. |
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