Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry

Johannes A. Govaert; Niki Lijftogt; Wouter A. Van Dijk; Larissa N.L. Tseng; Ronald S.L. Liem; Rob A.E.M. Tollenaar; Marta Fiocco; Michel W.J.M. Wouters; B. Lamme; D. A. Hess; H. J. Belgers; O. R. Guicherit; C. Rosman; H. J.T. Rutten; F. N.L. Versluijs-Ossewaarde; E. S. Van Der Zaag; L. N.L. Tseng; E. J.R. De Graaf; W. J. Vles; E. G.J.M. Pierik; H. A. Prins; P. H.M. Reemst; E. C.J. Consten; S. A. Koopal; P. A. Neijenhuis; G. H.H. Mannaerts; A. B. Smits; D. H.C. Burger; M. G.A. Van IJken; P. Poortman; M. J.P.M. Govaert; W. A. Bleeker; F. C. Den Boer; F. Wit; Ph M. Kruyt; A. Mearadji; J. T. Heikens

doi:10.1002/jso.24187

Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry

Johannes A. Govaert^*, Niki Lijftogt, Wouter A. Van Dijk, Larissa N.L. Tseng, Ronald S.L. Liem, Rob A.E.M. Tollenaar, Marta Fiocco, Michel W.J.M. Wouters, B. Lamme, D. A. Hess, H. J. Belgers, O. R. Guicherit, C. Rosman, H. J.T. Rutten, F. N.L. Versluijs-Ossewaarde, E. S. Van Der Zaag, L. N.L. Tseng, E. J.R. De Graaf, W. J. Vles, E. G.J.M. PierikH. A. Prins, P. H.M. Reemst, E. C.J. Consten, S. A. Koopal, P. A. Neijenhuis, G. H.H. Mannaerts, A. B. Smits, D. H.C. Burger, M. G.A. Van IJken, P. Poortman, M. J.P.M. Govaert^*, W. A. Bleeker, F. C. Den Boer, F. Wit, Ph M. Kruyt, A. Mearadji, J. T. Heikens

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and Objectives The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. Methods All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Results Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and =2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Conclusions Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery.

Original language	English
Pages (from-to)	489-495
Number of pages	7
Journal	Journal of Surgical Oncology
Volume	113
Issue number	5
DOIs	https://doi.org/10.1002/jso.24187
Publication status	Published - 1 Apr 2016

Keywords

colorectal cancer surgery
hospital costs
obesity

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10.1002/jso.24187

Cite this

Govaert, J. A., Lijftogt, N., Van Dijk, W. A., Tseng, L. N. L., Liem, R. S. L., Tollenaar, R. A. E. M., Fiocco, M., Wouters, M. W. J. M., Lamme, B., Hess, D. A., Belgers, H. J., Guicherit, O. R., Rosman, C., Rutten, H. J. T., Versluijs-Ossewaarde, F. N. L., Van Der Zaag, E. S., Tseng, L. N. L., De Graaf, E. J. R., Vles, W. J., ... Heikens, J. T. (2016). Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry. Journal of Surgical Oncology, 113(5), 489-495. https://doi.org/10.1002/jso.24187

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title = "Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry",

abstract = "Background and Objectives The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. Methods All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Results Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and =2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Conclusions Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the {"}obesity-paradox{"} for mortality in colorectal cancer surgery.",

keywords = "colorectal cancer surgery, hospital costs, obesity",

author = "Govaert, {Johannes A.} and Niki Lijftogt and {Van Dijk}, {Wouter A.} and Tseng, {Larissa N.L.} and Liem, {Ronald S.L.} and Tollenaar, {Rob A.E.M.} and Marta Fiocco and Wouters, {Michel W.J.M.} and B. Lamme and Hess, {D. A.} and Belgers, {H. J.} and Guicherit, {O. R.} and C. Rosman and Rutten, {H. J.T.} and Versluijs-Ossewaarde, {F. N.L.} and {Van Der Zaag}, {E. S.} and Tseng, {L. N.L.} and {De Graaf}, {E. J.R.} and Vles, {W. J.} and Pierik, {E. G.J.M.} and Prins, {H. A.} and Reemst, {P. H.M.} and Consten, {E. C.J.} and Koopal, {S. A.} and Neijenhuis, {P. A.} and Mannaerts, {G. H.H.} and Smits, {A. B.} and Burger, {D. H.C.} and {Van IJken}, {M. G.A.} and P. Poortman and Govaert, {M. J.P.M.} and Bleeker, {W. A.} and {Den Boer}, {F. C.} and F. Wit and Kruyt, {Ph M.} and A. Mearadji and Heikens, {J. T.}",

note = "Publisher Copyright: {\textcopyright} 2016 Wiley Periodicals, Inc.",

year = "2016",

month = apr,

day = "1",

doi = "10.1002/jso.24187",

language = "English",

volume = "113",

pages = "489--495",

journal = "Journal of Surgical Oncology",

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Govaert, JA, Lijftogt, N, Van Dijk, WA, Tseng, LNL, Liem, RSL, Tollenaar, RAEM, Fiocco, M, Wouters, MWJM, Lamme, B, Hess, DA, Belgers, HJ, Guicherit, OR, Rosman, C, Rutten, HJT, Versluijs-Ossewaarde, FNL, Van Der Zaag, ES, Tseng, LNL, De Graaf, EJR, Vles, WJ, Pierik, EGJM, Prins, HA, Reemst, PHM, Consten, ECJ, Koopal, SA, Neijenhuis, PA, Mannaerts, GHH, Smits, AB, Burger, DHC, Van IJken, MGA, Poortman, P, Govaert, MJPM, Bleeker, WA, Den Boer, FC, Wit, F, Kruyt, PM, Mearadji, A & Heikens, JT 2016, 'Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry', Journal of Surgical Oncology, vol. 113, no. 5, pp. 489-495. https://doi.org/10.1002/jso.24187

TY - JOUR

T1 - Colorectal cancer surgery for obese patients

T2 - Financial and clinical outcomes of a Dutch population-based registry

AU - Govaert, Johannes A.

AU - Lijftogt, Niki

AU - Van Dijk, Wouter A.

AU - Tseng, Larissa N.L.

AU - Liem, Ronald S.L.

AU - Tollenaar, Rob A.E.M.

AU - Fiocco, Marta

AU - Wouters, Michel W.J.M.

AU - Lamme, B.

AU - Hess, D. A.

AU - Belgers, H. J.

AU - Guicherit, O. R.

AU - Rosman, C.

AU - Rutten, H. J.T.

AU - Versluijs-Ossewaarde, F. N.L.

AU - Van Der Zaag, E. S.

AU - Tseng, L. N.L.

AU - De Graaf, E. J.R.

AU - Vles, W. J.

AU - Pierik, E. G.J.M.

AU - Prins, H. A.

AU - Reemst, P. H.M.

AU - Consten, E. C.J.

AU - Koopal, S. A.

AU - Neijenhuis, P. A.

AU - Mannaerts, G. H.H.

AU - Smits, A. B.

AU - Burger, D. H.C.

AU - Van IJken, M. G.A.

AU - Poortman, P.

AU - Govaert, M. J.P.M.

AU - Bleeker, W. A.

AU - Den Boer, F. C.

AU - Wit, F.

AU - Kruyt, Ph M.

AU - Mearadji, A.

AU - Heikens, J. T.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background and Objectives The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. Methods All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Results Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and =2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Conclusions Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery.

AB - Background and Objectives The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. Methods All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Results Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and =2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Conclusions Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery.

KW - colorectal cancer surgery

KW - hospital costs

KW - obesity

U2 - 10.1002/jso.24187

DO - 10.1002/jso.24187

M3 - Article

SN - 0022-4790

VL - 113

SP - 489

EP - 495

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

IS - 5

ER -