Abstract, Academic Surgical Congress 2013: See also paper: http://www.ncbi.nlm.nih.gov/pubmed/24139555 Introduction: Hospitals and surgeons are constantly striving to improve their outcomes. SCIP measures and guidelines to improve the quality of care are now commonplace. However, factors that are beyond the control of the medical community play an important role in outcomes. The United States continues to struggle with obesity. Obesity increases resection difficulty and could be predictive of a complicated postoperative course. Body Mass Index (BMI) is a continuous numeric expression of body habitus and allows for a quantification of the effect of body habitus on postsurgical complications. The aim of this study is therefore to measure the effect of BMI on the risk of wound-related postoperative complications. Methods: 851 patients were operated on for colonic adenocarcinoma at our tertiary care center between 2004 and 2011. Binomial logistic regression was used to assess for relationships between complications and incremental increases in BMI. We controlled in a separate univariate analysis for possibly significant predictive covariates, including age, gender, Charlson comorbidity score, approach, and intersurgeon variation. Results: After correction for statistically significant covariates, BMI proved to be a significant predictor of several wound-related complications. Using the same approach, all other major and minor complications within 30 days postoperatively did not show a significant relationship with BMI. In wound-related complications, the risk increase was independent on whether the approach was laparoscopic or open. Figure 1 shows the p-values for each complication that was significantly related to BMI and the Odds Ratio for each increase of one BMI unit (1 kg/m2). Conclusions: Obesity has a direct effect on wound complications in both open and laparoscopic procedures. Furthermore, BMI-related risk of wound-related complications increases exponentially with increasing weight. This incremental effect illustrates how an increasingly obese US population relates to an independently growing risk of surgical complications. As the surgical community strives to improve the quality of care, patient controllable factors will clearly play an increasingly important role in cost containment and quality improvement.

1. Obesity, Outcomes and Quality of Care:
BMI Increases the Risk of Wound-Related
Complications in Colon Cancer Surgery
Ramzi Amri
Department of General and Gastrointestinal Surgery
Harvard Medical School & Massachusetts General Hospital
8th
Academic Surgical Congress
February 5-7 2013, New Orleans, LA

2. Introduction
•The US continues to struggle with obesity
•Obesity is linked with colon cancer risk
•Obesity is an important surgical risk factor
•SCIP/NSQIP implemented at MGH for > 10 y
Current impact of BMI on complications after
colon cancer surgery?
ASC Quickshot 55.6: Amri et al.February 7th
2013

3. Methods
• MGH colon cancer surgeries (all: 2004-2011)
• BMI at surgery in WHO categories
(6: Underweight – Obese III)
• All major postop complications
• Multivariate logistic regression
(p-value, Odds Ratio, 95% CI)
ASC Quickshot 55.6: Amri et al.February 7th
2013

4. Results
• N=1071
• Most complications NS
• Except wound-related:
– Lap and open surgery
– Also in elective surgery
• Corrected for:
– Age
– Gender
– ASA score
– Smoking
• Forest plot
(all evaluated complications)
ASC Quickshot 55.6: Amri et al.February 7th
2013

5. ASC Quickshot 55.6: Amri et al.February 7th
2013

6. ASC Quickshot 55.6: Amri et al.February 7th
2013
*
*P <0.001

7. Definitions
• Wound infection:
Culture-ascertained infection of the operative
wound, or clinically ascertained case severe
enough to necessitate antibiotic treatment.
• Slow healing:
Issue in the operative wound needing targeted
intervention, but not necessarily of infectious
origin.

8. Summary
• Wound-related complications linked with BMI
• Odds increase per higher weight category
• Despite SCIP compliance
• SSI focus
• Outside of the control of the surgeon
• Challenge to the surgical community
ASC Quickshot 55.6: Amri et al.February 7th
2013

10. • Open and Lap: lap no effect on SSI rates:
Weight is a predictor strong enough to be
independent of approach.