H. Saiganesh1, D. Stein1, J. L. Poggio1 1Drexel University College Of Medicine,Department Of Surgery, Division Of Colorectal Surgery,Philadelphia, Pa, USA
Introduction: Obesity currently affects more than a third of the US population and is associated with increased surgical complications. Compared to all other subspecialties, colorectal surgery is the most affected by the increasing trend in obese surgical patients. Operative time has been found to have the greatest impact on hospital costs and physician workload. This study was conducted to determine whether obesity has a direct impact on operative time in elective colorectal surgical procedures using a high-powered, nationally representative patient sample.
Methods: A retrospective analysis was conducted on 45,362 patients who underwent open and laparoscopic ileocolic resections, partial colectomies, and low pelvic anastomoses using ACS-NSQIP data from 2005 to 2009. Operative time (in minutes) was the main outcome variable, while body mass index (in kg/m^2) was the main independent variable. Body mass index was divided into three classes: normal (<25), overweight/obese (25-35), and morbidly obese (>35). A univariate linear model was used to analyze the relationship while controlling for confounding factors such as demographics and preoperative conditions. Statistical significance was established at p < 0.05.
Results: Morbidly obese patients were found to have longer operative times than did normal patients across each individual colorectal surgical procedure (p < 0.001), ranging from a mean difference of 17.8 minutes for open ileocolic resections to 56.6 minutes for laparoscopic low pelvic anastomoses with colostomies.
Conclusions: BMI, as an objective measure of obesity, is a direct, statistically significant independent predictor of operative time across elective colorectal surgery procedures. We suggest future studies to further discuss the modification of surgical reimbursement to account for the greater procedural and temporal costs in treating obese patients.
