Postoperative outcomes in super- and super-super obese patients undergoing emergency abdominal surgery

With a rising prevalence of Class III obesity (BMI ≥40), it is crucial to identify the perioperative risks associated with super-obesity (BMI 50-59.9) and super-super-obesity (BMI ≥60) in patients undergoing emergency general surgery procedures. The American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database was queried for emergency abdominal surgeries between January 1, 2015 and December 31, 2019. 19,205 patients aged ≥18 years with a BMI ≥40 were included and stratified into morbidly obese, super-obese, and super-super-obese categories. The 30-day mortality rate in the super-super-obese group (7.2%) was significantly higher than the morbidly obese (4.1%) and super-obese (5.4%) groups. Compared to morbidly obese patients, super-obese and super-super-obese patients had significantly higher odds for septic shock and reoperation. Super-super-obese patients additionally had significantly higher odds for readmission. These findings suggest that super- and super-super-obese patients warrant tailored perioperative management and separate risk considerations.