Debunking the “Obesity Paradox”: Obesity Is Associated With Adverse Outcomes in Emergency General Surgery

• Published in: The Journal of surgical research 2024-09, Vol.301, p.95-102
• Main Authors: Lagazzi, Emanuele, Nzenwa, Ikemsinachi C., Rafaqat, Wardah, Panossian, Vahe S., Hoekman, Anne H., Arnold, Suzanne, Ghaddar, Karen A., Parks, Jonathan J., Paranjape, Charudutt N., Velmahos, George C., Kaafarani, Haytham M.A., Hwabejire, John O.
• Format: Article
• Language: English
• Subjects: BMI; Emergency surgery; Laparotomy; Obesity; Obesity paradox; Outcomes
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.05.040

Obesity is increasingly prevalent both nationwide and in the emergency general surgery (EGS) population. While previous studies have shown that obesity may be protective against mortality following EGS procedures, the association between body mass index (BMI) and postoperative outcomes, as well as intraoperative decision-making, remains understudied. The National Surgical Quality Improvement Program 2015-2019 database was used to identify all adult patients undergoing an open abdominal or abdominal wall procedure for EGS conditions. Our outcomes included 30-d postoperative mortality, composite 30-d morbidity, delayed fascial closure, reoperation, operative time, and hospital length of stay (LOS). Multivariable logistic regression models were used to explore the association between BMI and each outcome of interest while adjusting for patient demographics, comorbidities, laboratory tests, preoperative and intraoperative variables. We identified 78,578 patients, of which 3121 (4%) were categorized as underweight, 23,661 (30.1%) as normal weight, 22,072 (28.1%) as overweight, 14,287 (18.2%) with class I obesity, 7370 (9.4%) with class II obesity, and 8067 (10.3%) with class III obesity. Class III obesity was identified as a risk factor for 30-d postoperative morbidity (adjusted odds ratio 1.14, 95% CI, 1.03-1.26, P