Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery
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1 Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Zhobin Moghadamyeghaneh MD 1, Michael J. Stamos MD 1 1 Department of Surgery, University of California, Irvine
2 Nothing to Disclose
3 Introduction- Study Aims Literature Preoperative weight loss in patients with gastrointestinal cancer is an indicator of poor prognosis There are limited data regarding postoperative complications which have associations with weight loss in colon and rectal surgery Study Aims Incidence rate of weight loss Complications associated with weight loss Outcomes
4 Methods Retrospective Review National Surgical Quality Improvement Program (ACS NSQIP) database from Case Selection ICD-9 diagnosis and CPT procedure codes Weight loss: Losing weight more than 10% in six months Inclusion Criteria Adult patients who were admitted non-emergently and underwent colorectal resection.
5 Methods Exclusion Criteria Patients who underwent colorectal surgery without colon or rectal resection, patients with history of chemotherapy 30 days before operation, and patients with disseminated cancer were excluded from this study Variables Demographic data, comorbidities, procedures, postoperative complications
6 Methods Multivariate Analysis (Logistic Regression) Adjustments were made for : Comorbidities: Major comorbidities (HTN, CHF, CRF, COPD) and 10 other comorbid conditions Demographic conditions (age, sex, and race) Hypoalbuminemia Anemia Radiotherapy The technique of the surgery (open vs. laparoscopic) Wound classification
7 Results A total of 80,503 patients underwent colorectal resection 3,923 (4.9%) of patients had preoperative weight loss Variable Patients without weight loss Patients with weight loss P-value AOR and 95% CI Length of Stay 6 days 9 days P< ( ) Hypoalbuminemia 18.9% 48.9% P< ( ) Anemia 17.3% 40.8% P< ( )
8 Risk adjusted analysis of outcomes associated with preoperative weight loss in colon and rectal surgery patients Complication P-value Multivariate Analysis AOR and 95% CI Mortality < ( ) Overall Morbidity < ( ) Myocardial Infarction ( ) Unplanned Intubation < ( ) Pneumonia < ( ) Prolong Hospitalization < ( ) Ventilator Dependency < ( ) Sepsis < ( ) Organ Space SSI* < ( ) Septic Shock ( ) Wound Disruption ( ) Superficial SSI* ( ) Deep Incisional SSI* ( )
9 Risk adjusted analysis of pathologies associated with preoperative weight loss in colon and rectal surgery patients Patient-Pathology Univariate Analysis Multivariate Analysis P-value OR and AOR and P-value 95% CI 95% CI Benign Pathology Reference Reference Cancer in Pathology < ( ) < ( ) Colon Cancer Reference Reference Rectal Cancer ( ) ( ) Ulcerative Colitis < ( ) < ( ) Crohn's disease < ( ) < ( ) Rectal Cancer < ( ) ( Right Side Colon Cancer ( ) ( ) Diverticulitis of Colon < ( ) < ( ) Carcinoma In Situ ( ) ( ) Benign Colorectal Tumor < ( ) < ( ) Diverticulosis of Colon < ( ) < ( )
10 Rate of Preoperative Weight Loss According to Patients' Pathology
11 Limitations Retrospective Study We did not have information on the exact amount of weight loss
12 Conclusions Unintentional preoperative weight loss has an incidence rate of 4.9% in colorectal surgery. History of weight loss can be used to predict mortality and morbidity rates and as a marker for nutritional assessment in colorectal surgery There are associations between preoperative weight loss and preoperative hypoalbuminemia and anemia. Cardiopulmonary complications are at the top of the list of surgical complications associated with preoperative weight loss. IBD patients are the subset of CRS patients at the highest risk for preoperative weight loss.
13 Thank you!
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