Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database

Objective: To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design: Retrospective cohort study. Setting: Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods: The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m²≤ body mass index <30 kg/m²) and obese (≥30 kg/m²). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results: Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P <.001), rate of diabetes (18.2% vs 7.2%, P <.001), and rate of hypertension requiring medication (43.1% vs 23.0%, P <.001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P =.02) and have disseminated cancer (<1% vs 3.2%, P <.001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P =.027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P =.022). There was no statistical difference in medical complications (P =.775), unplanned readmissions (P =.286), unplanned reoperations (P =.053), or 30-day mortality (P >.999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion: Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.