Racial disparities in the impact of body mass index on perioperative outcomes of complex cancer surgery
Susanna W.L. de Geus1, Kurt Schultz1, Sing Chau Ng1, David McAneny1, Teviah E. Sachs1, Jennifer F. Tseng1 1Department of Surgery, Boston Medical Center, Boston, MA
Background:
Previous studies have suggested that the impact of body mass index (BMI) may be race-specific. Therefore, the purpose of this study was to investigate racial disparities in the impact of body mass index on postoperative outcomes for patients who underwent complex cancer surgery.
Methods:
Black, Asian, and White cancer patients who underwent esophagectomy, hepatectomy, gastrectomy, colectomy, or pancreatectomy were identified form the ACS-NSQIP (2008-2016) database. Multivariable logistic regression analyses predicting postoperative complications were performed, normal weight patients were used as a reference group.
Results:
In total, 12,062 Black, 5,505 Asian, and 89,010 White, patients were identified. Of the overall cohort, 31.9% was obese, 33.8% was overweight, 31.7% was normal weight, and 2.7% was underweight. Blacks race was associated with higher rates of obesity compared to Whites (32.5% vs. 37.2%; p<0.001). Asian patients were more often underweight (5.7% vs. 2.4%; p<0.001) and normal weight (57.1% vs. 30.6%; p<0.001) compared to White patients. On multivariable analyses, underweight was predictive for major complications in Asian (OR, 1.39; p=0.038), and White (OR, 1.32; p<0.001), but not in Black patients. In addition, being overweight was protective against major complications for Black patients (OR, 0.85; p<0.005). Furthermore, obesity was predictive for surgical site infections for Black (OR, 1.20; 0.010), Asian (OR, 1.50; p=0.003), and White (OR, 1.42; p<0.001) patients.
Conclusion:
In patients undergoing complex cancer surgery, underweight increased risk of major complication for Asian and White, but not for Black patients, which may have implications for preoperative optimization. Future studies are warranted.
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