PREOPERATIVE NUTRITION AND ELEVATED BODY MASS INDEX IN SURGICAL PATIENTS WITH CROHN'S DISEASE: TRENDS AND OUTCOMES
Michael Laffin*1,2, Jerry Dang2, Paolo Goffredo1, Adam Sang1, Audrey Kulaylat1, Janet T. Lee1, Haili Wang2
1Surgery, University of Minnesota, Minneapolis, MN; 2University of Alberta, Edmonton, AB, Canada
Optimization of pre-operative nutritional status is associated with improved outcomes. Patients affected by Crohn's disease often demonstrate nutritional deficiencies and a decreased body mass index (BMI), but a recent focus on nutrition in this population may affect postoperative outcomes. We aimed to identify trends in the preoperative nutritional status of patients with Crohn's disease undergoing surgical intervention and the associated impact on postoperative outcomes.
We used the ACS NSQIP targeted-colectomy database from 2012-2017 to examine trends in preoperative nutritional status and outcomes in patients with Crohn's disease. Elevated BMI was defined as BMI>25. Hypoalbuminemia was used as a marker for preoperative nutritional status and defined as albumin <3.5g/dL. The primary outcomes, rate of postoperative complication, were analyzed using multivariable logistic and linear regression analysis, correcting for preoperative demographics, comorbidities, and operative variables. Temporal trends were assessed using a modified Kruskal-Wallis test.
We identified 9432 Crohn's disease patients who underwent colectomy from 2012 to 2017. 53.4% were female, 44.9% had an elevated BMI, hypoalbuminemia was seen in 39.5%, and the median age was 39 years (IQR 29-58yrs).
Elevated BMI and hypoalbuminemia were independently associated with pulmonary embolism, ileus, and increased operative time (all p<0.01). Elevated BMI was significantly associated with increased superficial surgical site infection (p<0.001), and hypoalbuminemia was significantly associated with increased organ space infection (all p<0.05).
During the observed period, a significant trend was noted toward an increased proportion of elevated BMI patients undergoing surgery (p<0.01), and a decreased rate of hypoalbuminemia in surgical patients (p<0.01). However, the trend toward normalization in preoperative albumin over time was only seen in low and normal BMI groups (p=0.02) and not in the elevated BMI group (p>0.05).
Certain postoperative complications decreased over the course of the study period in low and normal BMI groups, but not in the elevated BMI groups, including urinary tract infection, and anastomotic leak (both p<0.01, fig 1). No reductions in postoperative complications were observed solely in the elevated BMI cohort.
An increasing proportion of surgical Crohn's disease patients have an elevated BMI. Preoperative hypoalbuminemia has become less prevalent in low and normal BMI patients, but elevated BMI patients did not demonstrate the same improvement. A lower rate of some complications was seen following colectomy from 2012 to 2017, however this improvement was not seen in the elevated BMI group, suggesting that nutritional optimization in the preoperative setting may be neglected in Crohn's disease patients with an elevated BMI.
Figure 1: Change in the rate of urinary tract infection and anastomotic leak from 2012 to 2017 in underweight and normal weight patients compared to those with an elevated BMI
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