Obesity in general elective surgery

Dindo, Daniel; Muller, Markus K; Weber, Markus; Clavien, Pierre-Alain

doi:10.1016/s0140-6736(03)13640-9

Cited by 631Cardiac, Anesthesia and Surgical OutcomesObesity, Physical Activity, DietBariatric Surgery and Outcomes

Obesity in general elective surgery

Dindo, Daniel, Muller, Markus K, Weber, Markus, Clavien, Pierre-Alain·2003·The Lancet

DOI 10.1016/s0140-6736(03)13640-9

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Abstract

Background Obese patients are generally believed to be at a higher risk for surgery than those who are not obese, although convincing data are lacking.Methods We prospectively investigated a cohort of 6336 patients undergoing general elective surgery at our institution to assess whether obesity affects the outcome of surgery. Exclusion criteria were emergency, vascular, thoracic, and bariatric operations; transplantation procedures; patients under immunosuppression; and operations done under local anaesthesia. Postoperative morbidity was analysed for non-obese and obese patients (body-mass index <30 kg/m(2) vs >or=30 kg/m(2)). Obesity was further stratified into mild obesity (30.0-34.9 kg/m(2)) and severe obesity (>or=35 kg/m(2)). Risk factors were analysed with univariate and multivariate models.Findings The cohort consisted of 6336 patients, of whom 808 (13%) were obese, 569 (9%) were mildly obese, and 239 (4%) had severe obesity. The morbidity rates in patients who were obese compared with those who were not were much the same (122 [15.1%] of 808 vs 901 [16.3%] of 5528; p=0.26), with the exception of an increased incidence of wound infections after open surgery in patients who were obese (17 [4%] of 431 vs 92 [3%] of 3555, p=0.03). Incidence of complications did not differ between patients who were mildly obese (91 [16.0%] of 569), severely obese (36 [15.1%] of 239), and non-obese (901 [16.3%] of 5528; p=0.19). In multivariate regression analyses, obesity was not a risk factor for development of postoperative complications. Of note, the additional medical resource use as estimated by a new classification of complications showed no differences between patients who were and were not obese.Interpretation Obesity alone is not a risk factor for postoperative complications. The regressive attitude towards general surgery in obese patients is no longer justified.

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The Clavien-Dindo classification is a widely adopted and validated system for grading the severity of complications.
“This classification is a widely adopted and validated system that grades the severity of complications based on the type of therapeutic intervention required.”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [20]

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RESEARCH ARTICLE Open Access Obesity – a risk factor for postoperative complications in general surgery?
Tjeertes, E. K. M., Hoeks, S. S. E., Valentijn, T. M., Hoofwijk, A. G. M., Jan, R., & Stolker, R. J. (2016)
Surgery in the obese
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(2015) · Colorectal Disease · doi:10.1111/codi.13051
Obesity – a risk factor for postoperative complications in general surgery?
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Determining Surgical Complications in the Overweight (DISCOVER): a multicentre observational cohort study to evaluate the role of obesity as a risk factor for postoperative complications in general surgery
Nepogodiev, D., Chapman, S. J., Glasbey, J. C., Kelly, M. E., Khatri, C., Drake, T. M., Kong, C. Y., Mitchell, H., Harrison, E. M., Fitzgerald, J. E. F., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008811 · Cited by 22 · see citing works

Authors: Dindo, D., Muller, M. K., Weber, M., & Clavien, P.-A.
Affiliations: University Hospital Zurich (CH)
Corresponding author: Clavien, Pierre-Alain
ORCID: Weber, Markus
Clavien, Pierre-Alain
Venue: The Lancet
Publisher: Elsevier BV
Published: 2003-06
Volume: 361
Issue: 9374
Pages: 2032-2035
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(03)13640-9
OpenAlex: W2135384303
Cited by: 630
References: 32
Citations by year: 2026: 3 · 2025: 19 · 2024: 16 · 2023: 20 · 2022: 22 · 2021: 23 · 2020: 26 · 2019: 31 · 2018: 16 · 2017: 25 · 2016: 49 · 2015: 33 · 2014: 32 · 2013: 45 · 2012: 39
FWCI: 12.56
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: Universität Zürich
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords: obesity, postoperative complications, postoperative morbidity, body mass index, wound infection, surgical risk factors, medical resource use, morbid obesity
MeSH terms: Adult, Analysis of Variance, Female, Humans, Length of Stay, Male, Middle Aged, Obesity, Postoperative Complications, Prospective Studies, Risk Factors, Surgical Wound Infection, Elective Surgical Procedures

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Obesity in general elective surgery

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