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Techniques in Coloproctology

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01-10-2019 | Obesity | Review

Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis

Authors: G. Hicks, A. Abdulaal, A. A. P. Slesser, Y. Mohsen

Published in: Techniques in Coloproctology | Issue 10/2019

Abstract

Background

Obesity is considered a risk factor for many chronic diseases and obese patients are often considered higher risk surgical candidates. The aim of this meta-analysis was to evaluate the outcomes of obese (body mass index ≥ 30 kg/m²) versus non-obese patients undergoing surgery for inflammatory bowel disease (IBD).

Methods

PubMed, Scopus, and Embase libraries were searched up to March 2019 for studies comparing outcomes of obese with non-obese patients undergoing surgery for IBD. A meta-analysis was conducted using Review Manager software to create forest plots and calculate odds ratios and mean differences.

Results

Four thousand three hundred and eleven patients from five observational studies were included. Obese patients were older at the time of surgery and more likely to have diabetes. Obese patients had longer operative times (MD 23.28, 95% CI 14.63–31.93, p < 0.001), higher intra-operative blood loss (MD 45.32, 95% CI 5.89–84.76, p = 0.02), longer length of stay (MD 0.90, 95% CI 0.60–1.20, p < 0.001), higher wound infection rates (OR 1.76, 95% CI 1.39–2.23, p < 0.001), and higher total postoperative complication rates (OR 1.33, 95% CI 1.04–1.70, p = 0.02).

Conclusions

Obesity is associated with significantly worse outcomes following IBD-specific surgery, including longer operative times, greater blood loss, longer length of stay, higher wound infection rates, and higher total postoperative complication rates. Clinicians should be mindful of these increased risks when counselling patients and consider weight reduction strategies where possible.

No Title. World Health Organization. https://www.who.int/topics/obesity/en/. Accessed 11 Sept 2019

Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. J Public Health (Oxf) 33:527–535. https://doi.org/10.1093/pubmed/fdr033 CrossRef

Boutros M, Maron D (2011) Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg 24:244–252. https://doi.org/10.1055/s-0031-1295687 CrossRefPubMedPubMedCentral

Steed H, Walsh S, Reynolds N (2009) A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts 2:370–372. https://doi.org/10.1159/000262276 CrossRefPubMedPubMedCentral

Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG et al (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858. https://doi.org/10.1007/s004640080069 CrossRefPubMed

Benoist S, Panis Y, Alves A, Valleur P (2000) Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 179:275–281CrossRefPubMed

Khoury W, Stocchi L, Geisler D (2011) Outcomes after laparoscopic intestinal resection in obese versus non-obese patients. Br J Surg 98:293–298. https://doi.org/10.1002/bjs.7313 CrossRefPubMed

Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250:166–172. https://doi.org/10.1097/SLA.0b013e3181ad8935 CrossRefPubMed

Blee TH, Belzer GE, Lambert PJ (2002) Obesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma? Am Surg 68:163–166PubMed

10.

Tjeertes EKM, Hoeks SE, Beks SBJ, Valentijn TM, Hoofwijk AGM, Stolker RJ (2015) Obesity—a risk factor for postoperative complications in general surgery? BMC Anesthesiol 15:112. https://doi.org/10.1186/s12871-015-0096-7 CrossRefPubMedPubMedCentral

11.

Flores A, Burstein E, Cipher DJ, Feagins LA (2015) Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci 60:2436–2445. https://doi.org/10.1007/s10620-015-3629-5 CrossRefPubMed

12.

Hu Q, Ren J, Li G, Wu X, Li J (2017) The impact of obesity on the clinical course of inflammatory bowel disease: a meta-analysis. Med Sci Monit 23:2599–2606CrossRefPubMedPubMedCentral

13.

Mendall MA, Gunasekera AV, John BJ, Kumar D (2011) Is obesity a risk factor for Crohn’s disease? Dig Dis Sci 56:837–844. https://doi.org/10.1007/s10620-010-1541-6 CrossRefPubMed

14.

Hass DJ, Brensinger CM, Lewis JD, Lichtenstein GR (2006) The impact of increased body mass index on the clinical course of Crohn’s disease. Clin Gastroenterol Hepatol 4:482–488. https://doi.org/10.1016/j.cgh.2005.12.015 CrossRefPubMed

15.

Blain A, Cattan S, Beaugerie L, Carbonnel F, Gendre JP, Cosnes J (2002) Crohn’s disease clinical course and severity in obese patients. Clin Nutr 21:51–57. https://doi.org/10.1054/clnu.2001.0503 CrossRefPubMed

16.

Lascano CA, Soto F, Carrodeguas L, Szomstein S, Rosenthal RJ, Wexner SD (2006) Management of ulcerative colitis in the morbidly obese patient: is bariatric surgery indicated? Obes Surg 16:783–786. https://doi.org/10.1381/096089206777346718 CrossRefPubMed

17.

Colombo F, Rizzi A, Ferrari C, Frontali A, Casiraghi S, Corsi F et al (2015) Bariatric surgery in patients with inflammatory bowel disease: an accessible path? Report of a case series and review of the literature. J Crohns Colitis 9:185–190. https://doi.org/10.1093/ecco-jcc/jju011 CrossRefPubMed

18.

Aminian A, Andalib A, Ver MR, Corcelles R, Schauer PR, Brethauer SA (2016) Outcomes of bariatric surgery in patients with inflammatory bowel disease. Obes Surg 26:1186–1190. https://doi.org/10.1007/s11695-015-1909-y CrossRefPubMed

19.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentral

20.

Guardado J, Carchman E, Danicic AE, Salgado J, Watson AR, Celebrezze JP et al (2016) Obesity does not impact perioperative or postoperative outcomes in patients with inflammatory bowel disease. J Gastrointest Surg 20:725–733. https://doi.org/10.1007/s11605-015-3060-4 CrossRefPubMed

21.

McKenna NP, Mathis KL, Khasawneh MA, Dozois EJ, Larson DW, Pemberton JH et al (2017) Obese patients undergoing ileal pouch-anal anastomosis: short-and long-term surgical outcomes. Inflamm Bowel Dis 23:2142–2146. https://doi.org/10.1097/MIB.0000000000001238 CrossRefPubMed

22.

Krane MK, Allaix ME, Zoccali M, Umanskiy K, Rubin MA, Villa A et al (2013) Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg 216:986–996. https://doi.org/10.1016/j.jamcollsurg.2013.01.053 CrossRefPubMed

23.

Causey MW, Johnson EK, Miller S, Martin M, Maykel J, Steele SR (2011) The impact of obesity on outcomes following major surgery for Crohn’s disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis Colon Rectum 54:1488–1495. https://doi.org/10.1097/DCR.0b013e3182342ccb CrossRefPubMed

24.

Pares D, Shamali A, Flashman K, O’Leary D, Senapati A, Conti J et al (2017) Laparoscopic surgical treatment of ileocecal Crohn’s disease: impact of obesity on short term results. Cir Esp 95:17–23. https://doi.org/10.1016/j.ciresp.2016.12.001 CrossRefPubMed

25.

Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T et al (2011) Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech 21:409–414. https://doi.org/10.1097/SLE.0b013e31822e5fdc CrossRefPubMed

26.

Park JW, Lim S-W, Choi HS, Jeong S-Y, Oh JH, Lim S-B (2010) The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc 24:1679–1685. https://doi.org/10.1007/s00464-009-0829-0 CrossRefPubMed

27.

Ding Z, Wu X-R, Remer EM, Lian L, Stocchi L, Li Y et al (2016) Association between high visceral fat area and postoperative complications in patients with Crohn’s disease following primary surgery. Colorectal Dis 18:163–172. https://doi.org/10.1111/codi.13128 CrossRefPubMed

28.

Connelly TM, Juza RM, Sangster W, Sehgal R, Tappouni RF, Messaris E (2014) Volumetric fat ratio and not body mass index is predictive of ileocolectomy outcomes in Crohn’s disease patients. Dig Surg 31:219–224. https://doi.org/10.1159/000365359 CrossRefPubMed

29.

Stidham RW, Waljee AK, Day NM, Bergmans CL, Zahn KM, Higgins PDR et al (2015) Body fat composition assessment using analytic morphomics predicts infectious complications after bowel resection in Crohn’s disease. Inflamm Bowel Dis 21:1306–1313. https://doi.org/10.1097/MIB.0000000000000360 CrossRefPubMedPubMedCentral

Title: Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis
Authors: G. Hicks
A. Abdulaal
A. A. P. Slesser
Y. Mohsen
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Obesity
Wound Infection
Obesity
Ulcerative Colitis
Crohn's Disease
Chronic Inflammatory Bowel Disease
Enterostomy
Proctocolectomy
Proctocolectomy
Enterostomy
Published in: Techniques in Coloproctology / Issue 10/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-019-02080-0

At a glance: The STEP trials

Springer Medicine

Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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