What Is the Target Body Mass Index for Elective Hartmann's Reversal? A NSQIP Analysis Using Stratum-Specific...

Area of Science:

• Colorectal Surgery
• Surgical Outcomes Research
• Obesity Medicine

Background:

• Obesity is linked to poor outcomes following Hartmann's reversal.
• Evidence-based body mass index (BMI) targets for elective Hartmann's reversal are lacking.
• This study aimed to identify BMI thresholds associated with 30-day postoperative morbidity.

Purpose of the Study:

• To establish data-driven body mass index (BMI) thresholds for elective Hartmann's reversal.
• To stratify patients based on BMI and associated risks of postoperative complications.
• To inform preoperative optimization strategies for patients undergoing Hartmann's reversal.

Main Methods:

• Retrospective cohort study using the ACS-NSQIP database (2015-2023).
• Included adults undergoing elective Hartmann's reversal (CPT codes 44626, 44227).
• Utilized stratum-specific likelihood ratio analysis and multivariable regression to identify BMI strata and associated complication risks.

Main Results:

• 16,027 patients were analyzed, identifying three risk-distinct BMI strata: 18.5-33.9 kg/m², 34-49.9 kg/m², and ≥50 kg/m².
• BMI 34-49.9 kg/m² (OR 1.38) and ≥50 kg/m² (OR 2.54) significantly increased odds of any postoperative complication.
• Elevated BMI correlated with increased odds of serious complications and surgical site infections, with rare mortality.

Conclusions:

• Data-driven BMI thresholds effectively stratify postoperative morbidity risk after Hartmann's reversal.
• Identified BMI thresholds can guide surgeons and patients in preoperative weight-loss optimization.
• These findings support evidence-based targets for improving surgical outcomes in obese patients.