Impact of Obesity on Surgical Outcomes in Patients Undergoing Emergency Laparotomy: A Prospective Observational Study.

Abstract

Background and aim: Obesity significantly impacts the outcomes of patients undergoing emergency laparotomy. It complicates emergency laparotomy by prolonging operative times, increasing risks due to comorbidities, impairing wound healing, and heightening respiratory complications, leading to higher morbidity, mortality, and healthcare costs. This study aimed to evaluate the impact of obesity on post-operative outcomes in patients undergoing emergency laparotomy at Kempegowda Institute of Medical Sciences (KIMS) Hospital and Research Centre, Bangalore. It focused on the association between body mass index (BMI) and the incidence of post-operative complications, length of hospital stay, and operative time.

Materials and methods: A total of 72 emergency laparotomy patients were grouped by BMI, normal vs. obese, as per the World Health Organization (WHO) classification. Comorbidities and surgical procedures were recorded, excluding laparoscopic cases and underweight patients. Post-operative complications were classified (Clavien-Dindo) and a comprehensive complication index assessed morbidity/mortality during hospitalization.

Results: The study included patients aged 18-88 years, with 48 having normal BMI and 24 classified as obese. Post-operative complications occurred more frequently in obese patients with comorbidities - diabetes (58.3%), hypertension (50%), CKD (4.2%), and IHD (4.2%) - compared to those with normal BMI (diabetes: 14.6%, hypertension: 20%). Notably, 66.7% of normal BMI patients had no complications. Obese patients had significantly longer operative times (by 44.23 minutes) and hospital stays (by 3.5 days).

Conclusion: The study demonstrates a significant impact of obesity on post-operative outcomes in patients undergoing emergency laparotomy. Additionally, the data show that a majority of patients with a normal BMI (66.7%), regardless of whether they had comorbid conditions, did not encounter any complications.