In this study, researchers examined 189,533 surgery cases that occurred between 2005 and 2006, focusing on if death occurred within 30 days post-surgery. As a result, they found that more than 3,245 people died within 30 days after surgery, totaling 1.7 percent.
After dividing up the patients into five different groups by their BMI’s, the researchers discovered an interesting trend. Patients with low BMI, lower that 23.1, had a significantly higher risk of death 30-days after general and vascular surgical procedures, compared to people with a BMI 35.3 or higher. People with BMI values 23.1 or less had a 40 percent higher risk of death, compared to people with BMI values between 26.3 to 29.6, considered overweight.
According to the U.S. Centers for Disease Control and Prevention (CDC), BMI values below 18.5 is considered underweight, BMI values between 18.5 and 24.9 is considered normal, BMI values between 25 to 29.9 is considered overweight, and BMI values over 30 is considered obese.
These individual types of procedures include procedures with which the general surgeon should have definite experience: colorectal resection, colostomy formation, cholecystectomy, hernia repair, mastectomy, and wound debridement," Stukenborg and colleagues wrote.
NSQIP data in the study were extracted from medical records at 183 participating hospitals. Those with low volumes reported all cases performed each year whereas high-volume hospitals reported the first 40 consecutive cases for 42 eight-day cycles each year.
Patients in the study were categorized into BMI quintiles, with values of less than 23.1 being the lowest and those above 35.2 being the highest. For the overall 30-day mortality risk calculation, the middle quintile -- 26.3 to 29.6 -- served as the reference.
BMI values of 20 to 25 are considered normal. A value of 30 is the standard threshold separating overweight from frank obesity.
Odds ratios for 30-day mortality in the two lowest and two highest quintiles were adjusted for procedure type and baseline mortality risk. The latter is a standard part of the NSQIP data and is calculated from more than 30 patient variables including sociodemographic factors, comorbidities, and preoperative laboratory values such as serum albumin and white blood cell count.
Only the lowest quintile showed a significant difference from the middle, reference quintile in the adjusted overall odds ratio for 30-day mortality:
Quintile 1: 1.40 (95% CI 1.25 to 1.58)
Quintile 2: 1.11 (95% CI 0.98 to 1.26)
Quintile 4: 1.02 (95% CI 0.89 to 1.17)
Quintile 5: 0.91 (95% CI 0.78 to 1.06)
Stukenborg and colleagues also evaluated 30-day mortality for 45 individual types of surgeries recorded as the "principal procedures" in the NSQIP data.
With laparoscopy as the reference, adjusted odds ratios for mortality ranged from 0.03 for breast lumpectomy to 2.47 for noncardiac vascular bypass and shunt procedures, before accounting for BMI.
The researchers found that mortality for a few procedures bucked the overall trend toward higher risk for low-BMI patients. For these, there were statistically significant increases in mortality associated with higher BMI, relative to laparoscopy.
These included temporary and permanent colostomies, ileostomies and other enterostomies, wound debridement, colorectal resection, therapeutic musculoskeletal procedures, endarterectomies in the head and neck, upper GI therapeutic procedures, cholecystectomies, hernia repairs, and mastectomies.
Limitations to the study included lack of data on nonfatal complications, use of hospital resources, or deaths beyond the 30-day mark. The possibility of inaccurate or incomplete data in the NSQIP database also cannot be excluded.
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