SHORT-TERM POSTOPERATIVE OUTCOMES FOR OBESE VERSUS NON-OBESE INFLAMMATORY BOWEL DISEASE PATIENTS UNDERGOING BOWEL RESECTION: A PROPENSITY SCORE MATCHED ANALYSIS
Tyler Mckechnie*, Lily J. Park, Yung Lee, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu
McMaster University, Hamilton, ON, Canada
Introduction: Inflammatory bowel disease (IBD) patients are classically malnourished and underweight. However, with the recent surge in obesity, the obese IBD patient has become increasingly pervasive. While obesity is a well-known risk factor for perioperative morbidity in patients undergoing abdominal surgery, this risk has never been quantified in obese IBD patients undergoing abdominal surgery. To inform this gap, we sought to compare post-operative morbidity outcomes between obese and non-obese patients undergoing bowel resection for IBD using the National Inpatient Sample (NIS).
Methods: A retrospective analysis of the NIS from 2015 to 2019 was conducted. Adult patients who underwent small bowel resection, colectomy, and/or proctectomy for IBD were identified using the relevant International Classification of Diseases, 10th revision codes. Patients were stratified into obese and non-obese groups using a BMI cut-off of 30kg/m2. A propensity score was assigned to each hospitalization based on the likelihood of treatment using multivariable logistic regression that included year of treatment, patient demographics, operative characteristics, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, specific postoperative complications, total admission healthcare cost, and length of stay (LOS). Univariable and multivariable regressions were utilized to compare the two groups.
Results: Overall, 6,601 patients were included in the non-obese group and 671 patients were included in the obese group. The propensity score matched cohort consisted of 659 patients in each arm without any significant differences in baseline variables. Adjusted analyses demonstrated significantly increased odds of experiencing postoperative in-hospital morbidity (aOR 1.50, 95%CI 1.10-2.03, p=0.010) in the obese cohort. Obese patients experienced significantly more gastrointestinal complications (aOR 1.49, 95%CI 1.00-2.24, p=0.05) and genitourinary complications (aOR 1.71, 95%CI 1.12-2.61, p=0.013) as compared to non-obese patients. There was no significant difference in total admission healthcare cost (MD -2256.32, 95%CI -19144.54-14631.9, p=0.79) or postoperative LOS (MD 0.16, 95%CI -0.93-1.27, p=0.77).
Conclusions: Obese IBD patients undergoing bowel resections are at greater risk of postoperative in-hospital morbidity than matched non-obese IBD patients. This is mostly drive by increased risk of gastrointestinal and genitourinary complications. The development of individualized pre-operative optimization protocols for obese surgical IBD patients are necessary to manage preoperative weight loss while avoiding malnutrition to optimize postoperative outcomes.
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