Mortality and Postoperative Outcomes in Super and Super-Super Obese Patients Undergoing Emergency Surgery

INTRODUCTION: Studies on class III obesity, defined by the CDC as BMI ≥40 kg/m2, have been limited and rarely stratify results by morbidly obese (MO, BMI ≥40 to 49.9 kg/m2), super obese (SO, BMI ≥50 to 59.9 kg/m2), and super-super obese (SSO, BMI ≥60 kg/m2) categories. The aim of this study is to investigate postoperative outcomes of SO and SSO patients undergoing emergency general surgery (EGS), and to determine whether class III obesity patients should be further substratified to reflect risk profiles of SO and SSO EGS patients. METHODS: The NSQIP database was queried for patients aged 18 to 89 years with BMI ≥40 kg/m2 undergoing EGS from 2015 to 2019. Patients were stratified into MO, SO, and SSO categories. The primary and secondary outcomes were 30-day postoperative death and morbidity. Descriptive statistics and multivariable logistic regression were performed. RESULTS: A total of 19,205 of 265,724 EGS patients were included: 14,814 MO (77.1%), 3,287 SO (17.1%), and 1,104 SSO (5.7%). SO and SSO patients had an increased odds for mortality and morbidity after EGS compared with MO patients (Table 1). In a subanalysis of emergency small-bowel and colon surgery, the odds for mortality in the SSO group were 2.02 times higher than in MO patients.Table 1CONCLUSION: This study is the first to investigate outcomes of SO and SSO EGS patients, demonstrating a significantly higher odds for 30-days mortality and complication compared with MO patients. Our findings suggest that SO and SSO EGS patients warrant separate risk consideration within current obesity classification systems, especially those undergoing emergency bowel operation.