Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 4/2017

01-04-2017 | Original Contributions

Prior Bariatric Surgery Is Linked to Improved Colorectal Cancer Surgery Outcomes and Costs: A Propensity-Matched Analysis

Authors: Hisham Hussan, Peter P. Stanich, Darrell M. Gray II, Somashekar G. Krishna, Kyle Porter, Darwin L Conwell, Steven K. Clinton

Published in: Obesity Surgery | Issue 4/2017

Login to get access

Abstract

Background

Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown.

Methods

The National Inpatient Sample Database (2006–2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m2 and BMI >35 kg/m2) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization.

Results

There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012. Prior bariatric surgery patients were younger, with fewer comorbidities, and had less emergency CRC surgery admissions (p < 0.05). Multivariate analyses revealed no adverse association (OR 0.54, 95 % CI = 0.16 to 1.79) between prior bariatric surgery and CRC perioperative mortality. Notably, multivariate analysis revealed that bariatric surgery patients undergoing CRC surgery had fewer accidental surgical lacerations (OR 0.38, 95 % CI = 0.15 to 0.93), shorter hospitalizations (−1.85 days, 95 % CI = 2.03 to 1.67), decreased total hospital costs (US$−5374, 95 % CI = −5935 to −4813) and lower disposition to short-term rehabilitation facilities (OR 0.65, 95 % CI = −0.43 to 0.97). Propensity score matched analysis validated these reductions in surgical complications and health care utilization in bariatric surgery patients, which were further more pronounced when bariatric surgery patients were restricted to BMI ≤35 kg/m2.

Conclusions

Analysis of national-level data demonstrates that prior bariatric surgery is associated with fewer colorectal cancer surgical complications and improved health care resource utilization compared to morbidly obese patients. These findings emphasize and extend the therapeutic effect of bariatric surgery to the colorectal cancer perioperative setting.
Appendix
Available only for authorised users
Literature
1.
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes. 2013;37(6):889–91.CrossRef
2.
3.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med, 1991. 115(12): p. 956–961.
4.
5.
Trastulli S et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9(5):816–29.CrossRefPubMed
6.
7.
Yamaura K et al. Effect of low-dose milrinone on gastric intramucosal pH and systemic inflammation after hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2001;15(2):197–203.CrossRefPubMed
8.
Vendrell J et al. Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity. Obes Res. 2004;12(6):962–71.CrossRefPubMed
9.
Laimer M et al. Markers of chronic inflammation and obesity: a prospective study on the reversibility of this association in middle-aged women undergoing weight loss by surgical intervention. Int J Obes Relat Metab Disord. 2002;26(5):659–62.CrossRefPubMed
10.
Trakhtenbroit MA et al. Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery. Am J Med. 2009;122(5):435–42.CrossRefPubMedPubMedCentral
11.
Brethauer SA et al. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients. Surg Endosc. 2011;25(8):2650–9.CrossRefPubMed
12.
Miller GD, Nicklas BJ, Fernandez A. Serial changes in inflammatory biomarkers after roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2011;7(5):618–24.CrossRefPubMedPubMedCentral
13.
Ben Q et al. Body mass index increases risk for colorectal adenomas based on meta-analysis. Gastroenterology. 2012;142(4):762–72.CrossRefPubMed
14.
15.
Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. Am J Clin Nutr. 2007;86(3):556–65.PubMed
16.
Okabayashi K et al. Body mass index category as a risk factor for colorectal adenomas: a systematic review and meta-analysis. Am J Gastroenterol. 2012;107(8):1175–85 quiz 1186.CrossRefPubMed
17.
18.
Hussan H, et al. (2015) Morbid obesity is associated with increased mortality, surgical complications, and incremental health care utilization in the peri-operative period of colorectal cancer surgery. World J Surg
19.
Nguyen NT et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg. 2005;140(12):1198–202 discussion 1203.CrossRefPubMed
20.
Ostlund MP, Lu Y, Lagergren J. Risk of obesity-related cancer after obesity surgery in a population-based cohort study. Ann Surg. 2010;252(6):972–6.CrossRefPubMed
21.
Derogar M et al. Increased risk of colorectal cancer after obesity surgery. Ann Surg. 2013;258(6):983–8.CrossRefPubMed
22.
Kant P et al. Rectal epithelial cell mitosis and expression of macrophage migration inhibitory factor are increased 3 years after roux-en-Y gastric bypass (RYGB) for morbid obesity: implications for long-term neoplastic risk following RYGB. Gut. 2011;60(7):893–901.CrossRefPubMed
23.
[September 11, H.C.-t.-C.R.C.F.U.A., Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Rockville, MD: Agency for Healthcare Research and Quality; 2001–2011.
24.
25.
Kalanithi PA, Arrigo R, Boakye M. Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine (Phila Pa 1976). 2012;37(11):982–8.CrossRef
26.
Shamji MF et al. Impact of body habitus on perioperative morbidity associated with fusion of the thoracolumbar and lumbar spine. Neurosurgery. 2009;65(3):490–8 discussion 498.CrossRefPubMed
27.
Krishna SG, et al. (2016) Effects of bariatric surgery on outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol
28.
Drolet S et al. Morbidity and mortality following colorectal surgery in patients with end-stage renal failure: a population-based study. Dis Colon rectum. 2010;53(11):1508–16.
29.
Kang CY et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg. 2012;204(6):952–7.CrossRefPubMed
30.
Elixhauser A et al. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.CrossRefPubMed
31.
32.
33.
34.
Broderick RC et al. Increasing the value of healthcare: improving mortality while reducing cost in bariatric surgery. Obes Surg. 2015;25(12):2231–8.CrossRefPubMed
35.
Mason RJ, Moroney JR, Berne TV. The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients. Ann Surg. 2013;258(4):541–51 discussion 551-3.PubMed
36.
Brian Moore P, Katharine Levit BA, Anne Elixhauser (2012) PhD., Healthcare Cost and Utilization Project (HCUP) Statistical briefs [Internet]. Costs for hospital stays in the United States, Statistical Brief #181
37.
Haider AH et al. Incremental cost of emergency versus elective surgery. Ann Surg. 2015;262(2):260–6.CrossRefPubMed
38.
Skala K et al. Risk factors for mortality-morbidity after emergency-urgent colorectal surgery. Int J Color Dis. 2009;24(3):311–6.CrossRef
39.
Bergstralh EJ, Kosanke J (1995) Computerized matching of cases to controls. Technical report No. 56. Department of Health Science Research Mayo Clinic, Rochester, MN
40.
Henkel DS et al. Trends in bariatric surgery for morbid obesity in Wisconsin: a 6-year follow-up. Wmj. 2010;109(1):21–7.PubMed
41.
Padwal RS. Characteristics of patients undergoing bariatric surgery in Canada. Obes Res. 2005;13(12):2052–4.CrossRefPubMed
42.
43.
Lieberman DA et al. Race, ethnicity, and sex affect risk for polyps >9 mm in average-risk individuals. Gastroenterology. 2014;147(2):351–8 quiz e14-5.CrossRefPubMedPubMedCentral
44.
Sainsbury A et al. Increased colorectal epithelial cell proliferation and crypt fission associated with obesity and roux-en-Y gastric bypass. Cancer Epidemiol Biomark Prev. 2008;17(6):1401–10.CrossRef
45.
Christou NV et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23 discussion 423-4.CrossRefPubMedPubMedCentral
46.
Adams TD et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.CrossRef
47.
Adams TD et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.CrossRefPubMed
48.
Sjostrom L et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.CrossRefPubMed
49.
Masoomi H et al. Predictive factors of in-hospital mortality in colon and rectal surgery. J Am Coll Surg. 2012;215(2):255–61.CrossRefPubMed
50.
Merkow RP et al. Effect of body mass index on short-term outcomes after colectomy for cancer. J Am Coll Surg. 2009;208(1):53–61.CrossRefPubMed
51.
Zhou Y et al. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26(3):783–9.CrossRefPubMed
52.
Cook CH et al. Survival of critically ill surgical patients discharged to extended care facilities. J Am Coll Surg. 1999;189(5):437–41.CrossRefPubMed
53.
54.
Legner VJ et al. The significance of discharge to skilled care after abdominopelvic surgery in older adults. Ann Surg. 2009;249(2):250–5.CrossRefPubMed
55.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr, 1998. 68(4): p. 899–917.
56.
Romero-Corral A et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes. 2008;32(6):959–66.CrossRef
57.
58.
Metadata
Title
Prior Bariatric Surgery Is Linked to Improved Colorectal Cancer Surgery Outcomes and Costs: A Propensity-Matched Analysis
Authors
Hisham Hussan
Peter P. Stanich
Darrell M. Gray II
Somashekar G. Krishna
Kyle Porter
Darwin L Conwell
Steven K. Clinton
Publication date
01-04-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 4/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2421-8

Other articles of this Issue 4/2017

Obesity Surgery 4/2017 Go to the issue

Original Contributions

Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass. Data from IFSO-European Chapter Center of Excellence Program

Letter to the Editor

Preservation of Fat-Free Mass After Bariatric Surgery: Our Point of View

Brief Communication

Type 2 Diabetes Remission After Roux-en-Y Gastric Bypass: Evidence for Increased Expression of Jejunal Genes Encoding Regenerating Pancreatic Islet-Derived Proteins as a Potential Mechanism

Original Contributions

QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation

How I Do It

Total Robotic Biliopancreatic Diversion with Duodenal Switch Technique

Letter to the Editor

What Is a Favourable Risk-Benefit Profile Concerning Metabolic Surgery for Patients with Type 2 Diabetes?