Maria Abou Khalil1, Nancy Morin2, Carol-Ann Vasilevsky2, Gabriela Ghitulescu2, Jennifer Motter3, Marylise Boutros2. 1McGill University, Montreal, QC, Canada, 2Jewish General Hospital, Montreal, QC, Canada, 3Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
Introduction: Obesity has been associated with increased morbidity following total proctocolectomies with ileal-pouch anal anastomosis (TPC-IPAA). However, the incremental added risk of increasing obesity class is not known. The aim of this study was to evaluate the additional morbidity of increasing obesity class for TPC-IPAA.
Methods: After ethics board approval, the ACS-NSQIP database(2005-2015) was accessed to identify patients who underwent elective TPC-IPAA. Body mass index(BMI,kg/m2) was classified as normal(18.5–24.9), overweight(25.0–29.9), obesity class-I(30-34.9), obesity class-II(35-39.9) and obesity class-III(≥40). Primary outcomes were overall surgical site infection(SSI) and organ-space infection(OSI). Secondary outcomes were 30-day major morbidity and length of hospital stay(LOS).
Results: Of 4581 patients who underwent TPC-IPAA, 57.4%, 17.6% and 9.8% were for ulcerative colitis, malignant colonic neoplasms and benign colonic neoplasms. Median(IQR) age was 44(31,56) years and 56.3% were male. Half (51.21%) of patients underwent a laparoscopic TPC-IPAA. Rates of overall SSI, OSI and major morbidity were 15.5%, 8.5% and 27.3%. Median LOS was 7(5,10) days. Over one-third of patients(38.5%) had a normal BMI, 4.1% were underweight, 32.9% were overweight, 16.0% were class-I obese, and 8.4% were class II/III obese. On multivariate regression analysis, higher obesity class was associated with significantly increased odds of SSI and OSI(Table 1). Similarly, increased risk of 30-day major morbidity and a one day increase in LOS were observed accross all obesity categories.
Conclusion: Increasing obesity class was associated with a significant incremental risk of SSI and OSI following TPC-IPAA. Knowledge of this increased risk stratified by obesity class may help guide preoperative planning, especially pertaining to counseling patients for staged procedures to allow for appropriate preoperative weight loss prior to IPAA reconstruction.
Table 1-Multivariate Regression for SSI and OSI (*Indicates statistical significance)
|SSI(OR 95%CI)||OSI(OR 95%CI)|
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86824
Program Number: P196
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster