Systematic Review and Meta-analysis: Association Between Obesity/overweight and Surgical Complications in IBD

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2022 May 31

PMID 35641579

Authors

Ke Jiang

Bangsheng Chen

Dandi Lou

Mengting Zhang

Yetan Shi

Wei Dai

Jingyi Shen

Bin Zhou

Jinxing Hu

Affiliations

Soon will be listed here.

Abstract

Purpose: While the prevalence of obesity in inflammatory bowel disease (IBD) patients is rapidly increasing, it is unclear whether obesity affects surgical outcomes in this population. This meta-analysis aims to assess the impact of obesity/overweight on patients undergoing surgery for IBD.

Methods: Databases (PubMed, Web of Science, Cochrane Library, and Springer) were searched through September 2021. The meta-analysis included patients with surgically treated IBD to investigate the impact of obesity/overweight on this population. Primary outcomes included overall complications, infectious complications, noninfectious complications, and conversion to laparotomy.

Results: Fifteen studies totaling 12,622 IBD patients were enrolled. Compared with nonobese (including overweight) patients, obese IBD patients have increased the risk in terms of overall complications (OR = 1.45, p < 0.001), infectious complications (OR = 1.48, p = 0.003) (especially wound complications), as well as conversion to laparotomy (OR = 1.90, p < 0.001). Among the noninfectious complications, only the incidence of visceral injury (OR = 2.36, p = 0.05) had significantly increased. Compared with non-overweight patients, the risk of developing wound complications (OR = 1.65, p = 0.01) and sepsis (OR = 1.73, p = 0.007) were increased in overweight patients, but the rates of overall complications (OR = 1.04, p = 0.81), infectious complications (OR = 1.31, p = 0.07), and conversion to laparotomy (OR = 1.33, p = 0.08) associated with body mass index (BMI) were not significantly different.

Conclusion: Obesity is a risk factor for surgical complications in IBD patients, mainly reflected in infectious complications. Moreover, obese patients seem to have a more common chance of developing surgical complications than overweight patients.

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References

Flegal K, Kit B, Orpana H, Graubard B . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013; 309(1):71-82. PMC: 4855514. DOI: 10.1001/jama.2012.113905. View

Canedo J, Pinto R, Regadas S, Regadas F, Rosen L, Wexner S . Laparoscopic surgery for inflammatory bowel disease: does weight matter?. Surg Endosc. 2010; 24(6):1274-9. DOI: 10.1007/s00464-009-0759-x. View

Manne A, Khan A, Malik T . Obesity and Outcome of Crohn's Associated Perianal Fistula Surgery: A Case-Control Study. Gastroenterology Res. 2016; 8(6):291-295. PMC: 5051028. DOI: 10.14740/gr698e. View

McKenna N, Habermann E, Zielinski M, Lightner A, Mathis K . Body mass index: Implications on disease severity and postoperative complications in patients with Crohn's disease undergoing abdominal surgery. Surgery. 2019; 166(4):703-708. DOI: 10.1016/j.surg.2019.04.038. View

Quaresma A, Barauna F, Teixeira F, Saad-Hossne R, Kotze P . Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review. J Clin Med. 2021; 10(4). PMC: 7916930. DOI: 10.3390/jcm10040710. View

Pikarsky A, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss E . Is obesity a high-risk factor for laparoscopic colorectal surgery?. Surg Endosc. 2002; 16(5):855-8. DOI: 10.1007/s004640080069. View

Davenport D, Xenos E, Hosokawa P, Radford J, Henderson W, Endean E . The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg. 2008; 49(1):140-7, 147.e1. DOI: 10.1016/j.jvs.2008.08.052. View

McKenna N, Habermann E, Glasgow A, Mathis K, Lightner A . Risk factors for readmission following ileal pouch-Anal anastomosis: an American College of Surgeons National Surgical Quality Improvement Program analysis. J Surg Res. 2018; 229:324-331. DOI: 10.1016/j.jss.2018.04.037. View

Okita Y, Araki T, Kondo S, Fujikawa H, Yoshiyama S, Hiro J . Clinical Characteristics of Stoma-Related Obstruction after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis. J Gastrointest Surg. 2016; 21(3):554-559. DOI: 10.1007/s11605-016-3329-2. View

10.

Ay C, Pabinger I, Cohen A . Cancer-associated venous thromboembolism: Burden, mechanisms, and management. Thromb Haemost. 2016; 117(2):219-230. DOI: 10.1160/TH16-08-0615. View

11.

Krane M, Allaix M, Zoccali M, Umanskiy K, Rubin M, Villa A . Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg. 2013; 216(5):986-96. DOI: 10.1016/j.jamcollsurg.2013.01.053. View

12.

Steed H, Walsh S, Reynolds N . A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts. 2010; 2(6):370-2. PMC: 6515793. DOI: 10.1159/000262276. View

13.

Harper J, Sinanan M, Zisman T . Increased body mass index is associated with earlier time to loss of response to infliximab in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013; 19(10):2118-24. DOI: 10.1097/MIB.0b013e31829cf401. View

14.

Sahami S, Bartels S, dHoore A, Fadok T, Tanis P, Lindeboom R . A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease. J Crohns Colitis. 2015; 10(7):773-8. DOI: 10.1093/ecco-jcc/jjv170. View

15.

Horio Y, Uchino M, Bando T, Chohno T, Takesue Y, Ikeuchi H . Association between Higher Body Mass Index and Pouch-Related Complications during Restorative Proctocolectomy in Patients with Ulcerative Colitis. Digestion. 2018; 98(4):257-262. DOI: 10.1159/000488583. View

16.

Windsor J, Kaplan G . Evolving Epidemiology of IBD. Curr Gastroenterol Rep. 2019; 21(8):40. DOI: 10.1007/s11894-019-0705-6. View

17.

Boutros M, Maron D . Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg. 2012; 24(4):244-52. PMC: 3311491. DOI: 10.1055/s-0031-1295687. View

18.

de la Garza-Ramos R, Bydon M, Abt N, Sciubba D, Wolinsky J, Bydon A . The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976). 2014; 40(1):56-61. DOI: 10.1097/BRS.0000000000000655. View

19.

Johnson A, Loftus E . Obesity in inflammatory bowel disease: A review of its role in the pathogenesis, natural history, and treatment of IBD. Saudi J Gastroenterol. 2021; 27(4):183-190. PMC: 8448008. DOI: 10.4103/sjg.sjg_30_21. View

20.

Seminerio J, Koutroubakis I, Ramos-Rivers C, Hashash J, Dudekula A, Regueiro M . Impact of Obesity on the Management and Clinical Course of Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015; 21(12):2857-63. DOI: 10.1097/MIB.0000000000000560. View