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News & Notes

Operating on Heavier Patients
Can Be a Good Thing
Patients with a low body mass
index are at the highest risk of
death following general or
vascular surgery, according to
an Archives of Surgery study.
Individuals with a BMI less
than 23.1 are twice as likely to
die than patients with a BMI of
35.3 or higher, and had a 40%
higher risk of death than
patients with a BMI between
26.3 and 29.6, say researchers
at the University of Virginia in
Charlottesville. They examined
the relationship between BMI
and 30-day mortality rates in
nearly 200,000 cases culled
from the American College of
Surgeons National Surgical
Quality Improvement Program.
Patients who underwent
exploratory laparotomy had the
highest death rate (14%), while

breast lumpectomy patients

were least likely to die (0.1%),
according to the study.
The researchers also discovered
a statistically significant
relationship between BMI and
mortality rates for patients
undergoing colostomy, wound
debridement, musculoskeletal
system procedures, upper GI
procedures, colorectal resection
and hernia repair compared
with patients who underwent
laparoscopy, which accounted
for 2% of patient deaths and
served as the mid-range
measuring stick used by the
researchers to classify
procedures as high or low risk.
Risks associated with operating
on heavier patients are under
increased scrutiny as adult
obesity has increased by more
than 100% since 1990, say the
researchers, who note that their
review of ACS data, as opposed
to previously published studies,
examined a wider range of
patients and specific
procedures. They say their
findings show that BMI is a

"significant" predictor of death

within 30 days post-op "even
after adjusting for the

contribution to mortality risk

made by type of surgery and for
a specific patient's overall
expected risk of death."
Daniel Cook

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