Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Study Variables
2.3.1. Definition of Obesity
2.3.2. Dependent Variables
2.4. Independent Variables
2.4.1. Demographic Variables
2.4.2. The Severity of CRC and Comorbidities
2.4.3. Hospital Characteristics
2.4.4. Statistical Analysis
3. Results
3.1. Baseline Data
3.2. The Effect of Obesity on Postoperative Complications
3.3. The Effects of Postoperative Complications on Outcomes
3.4. The Pathways of Obesity Affect Outcomes via the Complications
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Unmatched | Matched | |||||
---|---|---|---|---|---|---|
Non-Obese n = 98,655 | Obese n = 8412 | p | Non-Obese n = 33,644 | Obese n = 8411 | p | |
Demography | ||||||
Sex | ||||||
Male | ||||||
Female | 49,223 (49.9%) | 4468 (53.12%) | <0.0001 | 17,872 (53.12%) | 4468 (53.12%) | 1 |
Age (years) | ||||||
20–44 | 4800 (4.87%) | 438 (5.21%) | <0.0001 | 1752 (5.21%) | 438 (5.21%) | 1 |
45–59y | 21,048 (21.33%) | 2479 (29.47%) | 9916 (29.47%) | 2479 (29.47%) | ||
60–74y | 34,979 (35.46%) | 3779 (44.92%) | 15,116 (44.93%) | 3779 (44.93%) | ||
75+ | 37,828 (38.34%) | 1716 (20.4%) | 6860 (20.39%) | 1715 (20.39%) | ||
Race | ||||||
White | 76,725 (77.77%) | 6448 (76.65%) | <0.0001 | 25,745 (76.52%) | 6448 (76.66%) | <0.0001 |
Black | 9634 (9.77%) | 1039 (12.35%) | 3379 (10.04%) | 1039 (12.35%) | ||
Hispanic | 6460 (6.55%) | 601 (7.14%) | 2313 (6.87%) | 601 (7.15%) | ||
Asian or Pacific Islander | 3018 (3.06%) | 88 (1.05%) | 1173 (3.49%) | 88 (1.05%) | ||
Other | 2818 (2.86%) | 236 (2.81%) | 1034 (3.07%) | 235 (2.79%) | ||
Household income | ||||||
Q1 | 24,532 (24.87%) | 2225 (26.45%) | <0.0001 | 8052 (23.93%) | 2224 (26.44%) | <0.0001 |
Q2 | 24,934 (25.27%) | 2124 (25.25%) | 8439 (25.08%) | 2124 (25.25%) | ||
Q3 | 24,257 (24.59%) | 2155 (25.62%) | 8346 (24.81%) | 2155 (25.62%) | ||
Q4 | 24,932 (25.27%) | 1908 (22.68%) | 8807 (26.18%) | 1908 (22.68%) | ||
Elective admission | 64,127 (65%) | 5935 (70.55%) | <0.0001 | 22,779 (67.71%) | 5934 (70.55%) | <0.0001 |
CRC severity/comorbidities | ||||||
Severity of CRC | 34,884 (35.36%) | 2581 (30.68%) | <0.0001 | 10,320 (30.67%) | 2580 (30.67%) | 1 |
Alcohol abuse | 1896 (1.92%) | 145 (1.72%) | 0.2021 | 655 (1.95%) | 145 (1.72%) | 0.1807 |
Diabetes | 18,473 (18.72%) | 3425 (40.72%) | <0.0001 | 5877 (17.47%) | 3425 (40.72%) | <0.0001 |
Liver disease | 1809 (1.83%) | 249 (2.96%) | <0.0001 | 633 (1.88%) | 249 (2.96%) | <0.0001 |
Hospital | ||||||
Bed size | ||||||
Small | 12,136 (12.3%) | 944 (11.22%) | 0.009 | 4024 (11.96%) | 943 (11.21%) | 0.1192 |
Medium | 24,109 (24.44%) | 2121 (25.21%) | 8276 (24.6%) | 2121 (25.22%) | ||
Large | 62,410 (63.26%) | 5347 (63.56%) | 21,344 (63.44%) | 5347 (63.57%) | ||
Location | ||||||
Rural | 11,134 (11.29%) | 800 (9.51%) | <0.0001 | 3581 (10.64%) | 800 (9.51%) | 0.0024 |
Urban | 87,521 (88.71%) | 7612 (90.49%) | 30,063 (89.36%) | 7611 (90.49%) | ||
Teaching hospital | 43,760 (44.36%) | 3937 (46.8%) | <0.0001 | 14,904 (44.3%) | 3937 (46.81%) | <0.0001 |
Unmatched | Matched | |||||
---|---|---|---|---|---|---|
Non-Obese | Obese | p | Non-Obese | Obese | p | |
Outcome | ||||||
In-hospital mortality | 2977 (3.02%) | 148 (1.76%) | <0.0001 | 764 (2.27%) | 148 (1.76%) | 0.0039 |
Postoperative infection | 4402 (4.46%) | 526 (6.25%) | <0.0001 | 1419 (4.22%) | 526 (6.25%) | <0.0001 |
Postoperative shock | 398 (0.4%) | 48 (0.57%) | 0.0223 | 99 (0.29%) | 48 (0.57%) | 0.0001 |
Postoperative bleeding | 2223 (2.25%) | 214 (2.54%) | 0.0862 | 672 (2%) | 214 (2.54%) | 0.0018 |
Wound disruption | 1281 (1.3%) | 147 (1.75%) | 0.0006 | 358 (1.06%) | 147 (1.75%) | <0.0001 |
Digestive system complications | 12,395 (12.56%) | 1106 (13.15%) | 0.1215 | 3957 (11.76%) | 1106 (13.15%) | 0.0005 |
LOS a (days) | ||||||
Mean ± SD | 9.68 ± 8.17 | 9.52 ± 7.93 | 0.0641 | 9.08 ± 8.02 | 9.52 ± 7.93 | <0.0001 |
Median | 7 | 7 | 7 | 7 | ||
Total hospital charges (US dollars) b | ||||||
Mean ± SD | 68,547 ± 78,220 | 74,541 ± 82,478 | <0.0001 | 59,463 ± 68,653 | 74,545 ± 82,483 | <0.0001 |
Median | 46,456 | 51,745 | 40,420 | 51,762 | ||
Missing data | ||||||
In-hospital mortality | 61 | 0 | 9 | 0 | ||
LOS (days) | 2 | 0 | 1 | 0 | ||
Total hospital charges (US dollars) | 2651 | 503 | 1131 | 503 |
Infection | Shock | Bleeding | |||||||
---|---|---|---|---|---|---|---|---|---|
Explanatory Variables | ß | OR | ∂P/∂X | ß | OR | ∂P/∂X | ß | OR | ∂P/∂X |
Obesity | 0.43 | 1.54 (1.39, 1.71) | 0.0190 | 0.72 | 2.05 (1.45, 2.91) | 0.0025 | 0.24 | 1.28 (1.09, 1.49) | 0.0050 |
Race | |||||||||
Other | −0.02 | 0.98 (0.75, 1.29) | −0.0008 | 0.36 | 1.44 (0.63, 3.28) | 0.0013 | 0.15 | 1.16 (0.8, 1.67) | 0.0030 |
Asian or Pacific Islander | 0.23 | 1.26 (0.99, 1.62) | 0.0103 | 0.64 | 1.9 (0.92, 3.92) | 0.0022 | −0.16 | 0.86 (0.56, 1.32) | −0.0032 |
Hispanic | 0.004 | 1 (0.84, 1.2) | 0.0002 | 0.17 | 1.19 (0.65, 2.18) | 0.0006 | 0.02 | 1.02 (0.78, 1.33) | 0.0004 |
Black | 0.02 | 1.02 (0.88, 1.18) | 0.0009 | −0.12 | 0.89 (0.49, 1.59) | −0.0004 | −0.04 | 0.96 (0.76, 1.21) | −0.0009 |
Household income | |||||||||
Q4 | 0.06 | 1.06 (0.93, 1.22) | 0.0027 | 0.59 | 1.81 (1.09, 3.01) | 0.0021 | −0.02 | 0.98 (0.8, 1.2) | −0.0004 |
Q3 | 0.05 | 1.05 (0.92, 1.2) | 0.0022 | 0.48 | 1.61 (0.98, 2.67) | 0.0017 | 0.11 | 1.11 (0.92, 1.36) | 0.0022 |
Q2 | 0.01 | 1.01 (0.88, 1.15) | 0.0004 | 0.30 | 1.36 (0.81, 2.28) | 0.0011 | 0.09 | 1.09 (0.9, 1.33) | 0.0018 |
Elective Admission | −0.44 | 0.64 (0.58, 0.71) | −0.0195 | −0.65 | 0.52 (0.38, 0.73) | −0.0022 | −0.06 | 0.94 (0.81, 1.09) | −0.0013 |
Hospital location | |||||||||
Urban | 0.04 | 1.05 (0.88, 1.25) | 0.0020 | 1.06 | 2.87 (1.15, 7.17) | 0.0037 | −0.05 | 0.96 (0.75, 1.21) | −0.0009 |
Teaching Hospital | 0.33 | 1.39 (1.26, 1.53) | 0.0144 | −0.10 | 0.91 (0.65, 1.26) | −0.0003 | 0.08 | 1.09 (0.94, 1.25) | 0.0017 |
Constant | −3.08 | −0.1359 | −6.80 | −0.0237 | −3.89 | −0.0803 | |||
N | 1945 | 147 | 886 | ||||||
Likelihood ratio | 190.5245 | 47.52654 | 15.02153 | ||||||
−2 log L | 15, 564.86 | 1908.912 | 8578.129 | ||||||
Chi−square P | 205.1729 | 42.04551 | 15.11302 | ||||||
Dependent variable mean | 0.046 | 0.003 | 0.021 | ||||||
Wound disruption | Digestive system complications | ||||||||
Explanatory Variable | ß | OR | ∂P/∂X | ß | OR | ∂P/∂X | |||
Obesity | 0.51 | 1.66 (1.37, 2.02) | 0.0060 | 0.13 | 1.14 (1.06, 1.22) | 0.0135 | |||
Race | |||||||||
Other | −0.47 | 0.63 (0.33, 1.18) | −0.0056 | −0.10 | 0.91 (0.76, 1.08) | −0.0104 | |||
Asian or Pacific Islander | 0.003 | 1 (0.59, 1.72) | 0.00004 | −0.10 | 0.9 (0.75, 1.08) | −0.0110 | |||
Hispanic | 0.08 | 1.08 (0.78, 1.5) | 0.0009 | −0.18 | 0.84 (0.74, 0.95) | −0.0188 | |||
Black | −0.10 | 0.91 (0.68, 1.21) | −0.0012 | 0.10 | 1.1 (1, 1.21) | 0.0102 | |||
Household income | |||||||||
Q4 | −0.28 | 0.76 (0.58, 0.99) | −0.0033 | −0.04 | 0.96 (0.88, 1.05) | −0.0044 | |||
Q3 | −0.07 | 0.94 (0.73, 1.2) | −0.0008 | 0.01 | 1.01 (0.93, 1.1) | 0.0010 | |||
Q2 | −0.02 | 0.98 (0.77, 1.25) | −0.0002 | −0.02 | 0.98 (0.9, 1.07) | −0.0018 | |||
Elective Admission | −0.61 | 0.54 (0.45, 0.65) | −0.0072 | −0.17 | 0.85 (0.79, 0.9) | −0.0178 | |||
Hospital location | |||||||||
Urban | −0.24 | 0.79 (0.58, 1.07) | −0.0028 | 0.15 | 1.16 (1.04, 1.29) | 0.0155 | |||
Teaching Hospital | 0.46 | 1.58 (1.31, 1.92) | 0.0055 | −0.09 | 0.91 (0.86, 0.97) | −0.0096 | |||
Constant | −4.07 | −0.0483 | −1.98 | −0.2092 | |||||
N | 505 | 5063 | |||||||
Likelihood ratio | 94.76488 | 71.62981 | |||||||
−2 log L | 5375.543 | 30, 855.72 | |||||||
Chi-square P | 98.17657 | 71.09101 | |||||||
Dependent variable mean | 0.012 | 0.120 |
In-Hospital Mortality | |||
---|---|---|---|
Explanatory Variables | ß | OR | ∂P/∂X |
Infection | 0.83 | 2.3 (1.82, 2.9) | 0.0176 |
Shock | 2.45 | 11.64 (7.66, 17.68) | 0.0521 |
Bleeding | 0.57 | 1.77 (1.27, 2.47) | 0.0121 |
Wound disruption | 0.62 | 1.86 (1.23, 2.81) | 0.0132 |
Digestive system complications | 0.22 | 1.24 (1.03, 1.5) | 0.0046 |
Constant | −3.97 | −0.0842 | |
N | 912 | ||
Likelihood ratio | 218.2210 | ||
−2 log L | 8573.377 | ||
Chi-square P | 306.0189 | ||
Dependent variable mean | 0.022 |
Length of Stay | Total Charges (US Dollars) a | |||
---|---|---|---|---|
Explanatory Variables | ß | CI | ß | CI |
Infection | 8.42 | (8.07, 8.77) | 62,169 | (58,887, 65,451) |
Shock | 8.68 | (7.46, 9.89) | 85,247 | (73,746, 96,748) |
Bleeding | 3.15 | (2.65, 3.65) | 30,770 | (26,075, 35,464) |
Wound disruption | 11.09 | (10.43, 11.76) | 86,760 | (80,563, 92,958) |
Digestive system | 3.94 | (3.72, 4.16) | 23,378 | (21,302, 25,455) |
Constant | 8.08 | (8, 8.15) | 54,795 | (54,067, 55,523) |
N | 42,054 | 40,421 | ||
R2 | 0.1332 | 0.0886 | ||
Adjusted R2 | 0.1331 | 0.0885 |
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Chung, K.-C.; Lee, K.-C.; Chen, H.-H.; Cheng, K.-C.; Wu, K.-L.; Song, L.-C. Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study. J. Clin. Med. 2021, 10, 2904. https://doi.org/10.3390/jcm10132904
Chung K-C, Lee K-C, Chen H-H, Cheng K-C, Wu K-L, Song L-C. Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study. Journal of Clinical Medicine. 2021; 10(13):2904. https://doi.org/10.3390/jcm10132904
Chicago/Turabian StyleChung, Kuan-Chih, Ko-Chao Lee, Hong-Hwa Chen, Kung-Chuan Cheng, Kuen-Lin Wu, and Ling-Chiao Song. 2021. "Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study" Journal of Clinical Medicine 10, no. 13: 2904. https://doi.org/10.3390/jcm10132904