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

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. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.