Association of waist circumference with outcomes in an acute general surgical unit

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Excerpt

In 2015, there were 11.2 million (63.4%) overweight or obese people in Australia, of whom 4.9 million (27.9%) were obese.1 This has increased from 56.3% in 19951 and is comparable to similar countries.2 Rates are higher in regional areas (69.2%) when compared to adults in major cities (61.1%).1
Obesity is associated with many co‐morbidities, notably cardiovascular disease, type two diabetes mellitus (T2DM), certain cancers and all‐cause mortality.3 The financial impact of obesity to Australia is projected to be $87.7 billion through direct and indirect costs over the next decade if current trends continue.8
Obesity is common amongst surgical patients with reported rates approaching 70%.9 It is therefore important to determine the impact of obesity on surgical outcomes. The association of obesity with length of stay (LOS) is uncertain. When general surgical conditions are analyzed together, obesity, as measured using body mass index (BMI) is not associated with an increased LOS10 but when individual conditions, such as biliary disease, are analyzed separately a clear relationship between obesity and increasing LOS has been reported.11
There is also an association between obesity and major post‐operative complications in general surgical patients undergoing surgery for malignancy.9 Obesity has also been associated with increased rates of wound infection and breakdown.9
Few studies have examined the association of obesity with outcomes in acute surgical patients. The limited research in this area uses BMI as the means of quantifying obesity, with no reported studies using waist circumference (WC). Difficulties with moving acutely unwell patients and the inherent time pressures within an acute surgical unit (ASU) make BMI difficult to reliably collect. WC best predicts morbidity and all‐cause mortality when compared to other anthropometric measures14 and may be a more appropriate measure in the acute setting.
This study aimed to quantify rates of increased‐risk and high‐risk WC (according to World Health Organization (WHO) definitions) amongst ASU patients and analyze any association with surgical outcomes, in a non‐elective setting in regional New South Wales, Australia. Our hypothesis was that high‐risk WC would be associated with an increased LOS and a higher rate of adverse outcome measures.
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