Skip to main content

Advertisement

SpringerLink
Log in

The combined effect of age and body mass index on outcomes in foregut surgery: a regression model analysis of the National Surgical Quality Improvement Program data

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

In a parallel demographic phenomenon, the elderly and obese populations will become a larger part of our population and surgical practices. The elderly obese surgical risk profile is not clearly defined, although studies have confirmed their independent negative effect on surgical outcomes. Benign foregut surgery is a relatively common complex procedure performed on this demographic and warrants deeper investigation into outcomes. We investigate the synergistic effect of age and body mass index (BMI) on the outcomes of benign foregut surgery.

Methods

Data from National Surgical Quality Improvement Program were collected for all patients undergoing foregut surgery from 2005 to 2012. Subjects were over 18 years of age and 16 BMI. Primary and secondary outcomes were 30-day mortality and overall 30-day morbidity, respectfully. Binary logistic regression models were used to assess independent and interactive effects of age and BMI.

Results

A total of 19,547 patients had an average age and BMI of 57 and 29.7, respectively. Sample 30-day mortality was 0.32 %. Every 10-year age increase led to a 46 % increased odds of mortality. BMI showed a bimodal distribution with underweight and morbidly obese patients having increased mortality. The effect of BMI only became apparent with increasing age.

Conclusions

Both age and BMI are independent predictors of mortality; only older patients experienced the bimodal BMI effect. Therefore, increasing age and BMI have a synergistic effect on outcomes after foregut operations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wang Y, Beydoun MA (2007) The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28

    Article  CAS  PubMed  Google Scholar 

  2. Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, Dietz W (2012) Obesity and severe obesity forecasts through 2030. Am J Prev Med 41:563–570

    Article  Google Scholar 

  3. Ortman JM, Velkoff VA. Hogan H. (2014) An Aging Nation: the older population in the United States (Current Population Reports, US Department of Commerce Economics and Statistics Administration), US Census Bureau. pp 1–28

  4. Wiener JM, Tilly J (2002) Population aging in the United States of America: implications for public programmes. Int J Epidemiol 31:776–781

    Article  PubMed  Google Scholar 

  5. Fakhouri TH, Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity among older adults in the United States, 2007–2010. NCHS Data Brief. 106:1–8

    PubMed  Google Scholar 

  6. Chait MM (2010) Gastroesophageal reflux disease: important considerations for the older patients. J Gastrointest Endosc 2:388–396

    Article  Google Scholar 

  7. Johnson DA, Fennerty MB (2004) Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterol. 126:660–664

    Article  Google Scholar 

  8. Anggiansah R, Sweis R, Anggiansah A, Wong T, Cooper D, Fox M (2013) The effects of obesity on esophageal function, acid exposure and the symptoms of gastro-esophageal reflux disease. Aliment Pharmacol Ther 37:555–563

    Article  CAS  PubMed  Google Scholar 

  9. El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR (2007) Obesity increases esophageal acid exposure. Gut 56:749–755

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wilson LJ, Ma W, Hirschowitz B (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94:2840–2844

    Article  CAS  PubMed  Google Scholar 

  11. Funk LM, Kanji A, Melvin S, Perry KA (2014) Elective antireflux surgery in the US: an analysis of national trends in utilization and inpatient outcomes from 2005 to 2010. Surg Endosc 28:1712–1719

    Article  PubMed  Google Scholar 

  12. Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867

    Article  CAS  PubMed  Google Scholar 

  13. Finalyson SR, Stroupe KT, Joseph GJ, Fisher ES (2002) Using the Veterans Health Administration inpatient care database: trends in the use of antireflux surgery. Eff Clin Pract 5:E5

    PubMed  Google Scholar 

  14. Wang Y, Dempsey D, Ritcher J (2011) Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus 24:215–223

    Article  CAS  PubMed  Google Scholar 

  15. Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY (2009) Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg 144:1013–1020

    Article  PubMed  Google Scholar 

  16. Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO (2014) Outcomes of operations for benign foregut disease in elderly patients: a National Surgical Quality Improvement Program database analysis. Surgery 156:352–360

    Article  PubMed  Google Scholar 

  17. Ng V, Booth M, Stratford J et al (2007) Laparoscopic anti-reflux surgery is effective in obese patients with gastro-esophageal reflux disease. Ann R Coll Surg Engl 89:696–702

    Article  PubMed  PubMed Central  Google Scholar 

  18. Spaniolas K, Laycock W, Adrales G, Trus TL (2014) Laparoscopic paraesophageal hernia repair: advanced age is associated with minor but not major morbidity or mortality. J Am Coll Surg 218:1187–1192

    Article  PubMed  Google Scholar 

  19. Gangopadhyay N, Perrone J, Soper N, Matthews BD, Eagon JC, Klingensmith ME, Frisella MM, Brunt LM (2006) Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery. 140:491–498

    Article  PubMed  Google Scholar 

  20. Larusson H, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D (2009) Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg 33:980–985

    Article  PubMed  Google Scholar 

  21. Lidor A, Chang D, Feinberg R, Steele KE, Schweitzer MA, Franco MM (2011) Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis. Surg Endosc 25:3101–3108

    Article  PubMed  Google Scholar 

  22. Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877

    Article  PubMed  Google Scholar 

  23. Greenburg AG, Saik RP, Coyle JJ, Peskin GW (1981) Mortality and gastrointestinal surgery in the aged: elective vs emergency procedures. Arch Surg 116:788–791

    Article  CAS  PubMed  Google Scholar 

  24. Crandon IW, Harding H, Carpenter R, Branday JM, Simeon DT (2005) Surgery in the elderly: is age a risk factor? West Indian Med J 54:171–175

    CAS  PubMed  Google Scholar 

  25. Vincent GK, Velkoff VA. (2010) The next four decades: the older population in the United States-population estimates and predictions. US Census Bureau

  26. Silber JH, Rosenbaum PR, Kelz RR, Reinke CE, Neuman MD, Ross RN, Even-Shoshan O, David G, Saynisch PA, Kyle FA, Bratzler DW, Fleisher LA (2012) Medical and financial risks associated with surgery in the elderly obese. Ann Surg 256:79–86

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mathus-Vliegen EM, Basdevant A, Finer N, Hainer V, Hauner H, Micic D, Maislos M, Roman G, Schutz Y, Tsigos C, Toplak H, Yumuk V, Zahorska-Markiewicz B (2012) Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts. 5:460–483

    Article  CAS  PubMed  Google Scholar 

  28. Wannamethee SG, Shaper AG, Whincup PH, Walker M (2004) Overweight and obesity and the burden of disease and disability in elderly men. Int J Obes Relat Metab Disord 28:1374–1382

    Article  Google Scholar 

  29. Wigfield CH, Lindsey JD, Muñoz A, Chopra PS, Edwards NM, Love RB (2006) Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI ≥ 40. Eur J Cardiothorac Surg 29:434–440

    Article  PubMed  Google Scholar 

  30. Yap CH, Mohajeri M, Yii M (2007) Obesity and early complications after cardiac surgery. Med J Aust 186:350–354

    PubMed  Google Scholar 

  31. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH (2005) Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation 112:3247–3255

    Article  PubMed  Google Scholar 

  32. Lee CT, Dunn RL, Chen BT, Joshi DP, Sheffield J, Montie JE (2004) Impact of body mass index on radical cystectomy. J Urol 172:1281–1285

    Article  PubMed  Google Scholar 

  33. Cantiello F, Cicione A, Autorino R, De Nunzio C, Salonia A, Briganti A, Aliberti A, Perdonà S, Tubaro A, Damiano R (2014) Metabolic syndrome, obesity, and radical cystectomy complications: a clavien classification system-based analysis. Clin Genitourin Cancer 12:384–393

    Article  PubMed  Google Scholar 

  34. Behzadi AH, Kamali K, Zargar M, Abbasi MA, Piran P, Bastani B (2014) Obesity and urologic complications after renal transplantation. Saudi J Kidney Dis Transpl 25(2):303–308

    Article  PubMed  Google Scholar 

  35. Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X (2015) The influence of obesity on primary total hip arthroplasty outcomes: a meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res. 25:S1877-0568

    Google Scholar 

  36. Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM (2011) Obesity in total hip arthroplasty-does it really matter? A meta-analysis. Acta Orthop 82:417–422

    Article  PubMed  PubMed Central  Google Scholar 

  37. Petrella F, Radice D, Borri A, Galetta D, Gasparri R, Solli P, Veronesi G, Spaggiari L (2011) The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg 39:738–744

    Article  PubMed  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. Giles KA, Wyers MC, Pomposelli FB, Hamdan AD, Ching YA, Schermerhorn ML (2010) The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the national surgical quality improvement program 2005–2007. J Vasc Surg 52:1471–1477

    Article  PubMed  PubMed Central  Google Scholar 

  40. Vaduganathan M, Lee R, Beckham AJ, Andrei AC, Lapin B, Stone NJ, McGee EC Jr, Malaisrie SC, Kansal P, Silverberg RA, Lloyd-Jones DM, McCarthy PM (2012) Relation of body mass index to late survival after valvular heart surgery. Am J Cardiol 110:1667–1668

    Article  PubMed  Google Scholar 

  41. Jackson RS, Black JH, Lum YW, Schneider EB, Freischlag JA, Perler BA, Abularrage CJ (2012) Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy. J Vasc Surg 55:1306–1312

    Article  PubMed  Google Scholar 

  42. Miller M, Delaney C, Penna D, Liang L, Thomas J, Puckridge P, Spark JI (2012) A 3-year follow-up study of inpatients with lower limb ulcers: evidence of an obesity paradox? J Multidiscip Healthc. 5:181–186

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. Nafiu OO, Shanks AM, Hayanga AJ, Tremper KK, Campbell DA Jr (2011) The impact of high body mass index on postoperative complications and resource utilization in minority patients. J Natl Med Assoc 103:9–15

    Article  PubMed  Google Scholar 

  45. Davenport DL, Holsapple CW, Conigliaro J (2009) Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University Health System Consortium Clinical Database and the National Surgical Quality Improvement Program data set. Am J Med Qual 24(5):395–402

    Article  PubMed  Google Scholar 

  46. Cima RR, Lackore KA, Nehring SA, Cassivi SD, Donohue JH, Deschamps C, Vansuch M, Naessens JM (2011) How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution. Surgery. 150:943–949

    Article  PubMed  Google Scholar 

  47. Vaid S, Bell T, Grim R, Ahuja V (2012) Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data. Perm J 16:10–17

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Public Health, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, USA

    Prashanth Palvannan

  2. Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA

    Irving Miranda & Aziz M. Merchant

Authors
  1. Prashanth Palvannan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irving Miranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aziz M. Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aziz M. Merchant.

Ethics declarations

Disclosures

Drs. Irving Miranda, Prashanth Palvannan, and Aziz Merchant have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palvannan, P., Miranda, I. & Merchant, A.M. The combined effect of age and body mass index on outcomes in foregut surgery: a regression model analysis of the National Surgical Quality Improvement Program data. Surg Endosc 30, 2572–2582 (2016). https://doi.org/10.1007/s00464-015-4529-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4529-7

Keywords

Search

Navigation