Obesity as a Risk Factor for Unanticipated Admissions After Ambulatory Surgery

doi:10.4065/83.8.908

Mayo Clinic Proceedings

Volume 83, Issue 8, August 2008, Pages 908-913

https://doi.org/10.4065/83.8.908 Get rights and content

OBJECTIVE

To test the hypothesis that obesity is an independent risk factor for unplanned hospital admission or readmission among patients scheduled for ambulatory surgery in a tertiary medical center.

PATIENTS AND METHODS

Existing databases were used to identify 235 obese patients (body mass index [BMI] >40) scheduled for ambulatory surgery from January 2, 2002, through December 31, 2003, at Mayo Clinic's site in Rochester, MN. Each patient was matched to a normal-weight control (BMI <25) by age, sex, surgical procedure, type of anesthesia, and date of surgery, and the medical records of all patients were reviewed. Conditional logistic regression analysis was performed to assess whether obesity is an independent risk factor for unplanned postoperative hospital admission. In all cases, 2-sided tests were performed. P<.05 was considered statistically significant.

RESULTS

Obese patients (mean ± SD BMI, 44±4) were matched with control patients (mean ± SD BMI, 23±2). Comorbidity was more frequent in the obese cohort. The frequency of unplanned hospital admission did not differ between groups: 61 obese patients (26.0%) and 52 control patients (22.1%) were admitted (odds ratio, 1.3; 95% confidence interval, 0.8-2.0; P=.30).

CONCLUSION

Obesity is not a significant independent risk factor for unplanned admission after ambulatory surgery, suggesting that obesity per se should not prevent ambulatory surgery from being scheduled.

Section snippets

PATIENTS AND METHODS

This study was approved by the Mayo Clinic Institutional Review Board. Anesthesiology databases that contain information regarding patient and procedural characteristics were used to identify obese patients (defined as BMI >40) scheduled for ambulatory surgery at Mayo Clinic's site in Rochester, MN, from January 2, 2002, to December 31, 2003. For eligible patients who had ambulatory surgery more than once during this period, only the first eligible procedure was examined. For each obese

RESULTS

A total of 235 patients (mean ± SD BMI, 44±4) were included in the obese group. An equal number of control patients (mean ± SD BMI, 23±2) were matched exactly for sex, type of anesthesia, and surgical procedure. For the other matching variables, 99% of the control patients were matched for age within 5 years (range, 0-13 years), and 86% were matched within 1 year of surgical date (range, 0-1.9 years). Obese patients were more likely to have diabetes, hypertension, cardiovascular disease,

DISCUSSION

The major finding of this study is that obese patients scheduled for ambulatory surgery were not admitted postoperatively more frequently than their counterparts of normal weight matched for age, sex, anesthesia type, date of surgery, and surgical procedure. Obese patients were more likely to develop bronchospasm and to require supplemental oxygen and treatment for postoperative nausea or vomiting, but these events were not associated with more postoperative hospital admissions.

Obesity is a

CONCLUSION

We conclude that obesity is not a significant independent risk factor for unanticipated hospital admissions or readmissions after ambulatory surgery in a tertiary care center, despite the additional burden of comorbidity (such as OSA) borne by obese patients.

Acknowledgments

We thank Janet Beckman for secretarial support and Sara Achenbach for statistical support.

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While higher BMI was associated with a higher rate of transfer out of JRSC (p = 0.014), the difference in rate was small (mean risk 0.8% for BMI 25 vs 1.3% for BMI 40, difference in risk 0.52%, 95% CI 0.05%, 1.0%). We found no evidence that higher BMI increased the risk of urgent care visits or readmissions within 30 days or outpatient LOS (p = 0.7 for all). There was a statistically but not clinically significant difference in operative time for outpatient procedures (p = <0.0001), with a mean operative time of 59 vs 63 min for BMI 25 vs 40. Ambulatory extended recovery patients with higher BMI had shorter operative times (p < 0.0001). Patients with higher BMI were not significantly less likely to undergo surgery at JRSC (84% vs 83% vs 82% probability of treatment at JRSC for BMI 25, BMI 40 or BMI 50, respectively, p = 0.089).
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ORIGINAL ARTICLEObesity as a Risk Factor for Unanticipated Admissions After Ambulatory Surgery

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSION

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Acknowledgments

Br J Anaesth

Br J Anaesth

J Am Coll Surg

Lancet

Am J Med

Br J Anaesth

Br J Anaesth

Overweight, obesity, and health risk

Arch Intern Med

Body-mass index and mortality in a prospective cohort of U.S. adults

N Engl J Med

Postoperative nausea and vomiting: its etiology, treatment, and prevention

Anesthesiology

Diseases and problems secondary to massive obesity

Eur J Gastroenterol Hepatol

The effect of body mass index on complications from cardiac surgery in the oldest old

J Am Geriatr Soc

Guidelines for day case surgery: a report of the Royal College of Surgeons of England, revised edition

ORIGINAL ARTICLE
Obesity as a Risk Factor for Unanticipated Admissions After Ambulatory Surgery