{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T20:42:58Z","timestamp":1765485778410},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2014,5,15]],"date-time":"2014-05-15T00:00:00Z","timestamp":1400112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,6,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Body mass index (BMI) is a strong predictor of mortality in the general population. In spite of the medical hazards of obesity, a protective effect on mortality has been suggested in surgical patients: the obesity paradox. The aim of the present nationwide cohort study was to examine the association between BMI and mortality in patients treated surgically for perforated peptic ulcer (PPU).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a national prospective cohort study of all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009, for whom BMI was registered. Non-surgically treated patients and those with malignant ulcers were excluded. The primary outcome measure was 90-day mortality. The association between BMI and mortality was calculated as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2668 patients who underwent surgical treatment for PPU, 1699 (63\u00b77 per cent) had BMI recorded. Median age was 69\u00b74 (range 17\u00b76\u2013100\u00b79) years and 53\u00b77 per cent of the patients were women. Some 1126 patients (66\u00b73 per cent) had at least one of six co-morbid diseases; 728 (42\u00b78 per cent) had an American Society of Anesthesiologists grade of III or more. A total of 471 patients (27\u00b77 per cent) died within 90 days of surgery. Being underweight was associated with a more than twofold increased risk of death following surgery for PPU (adjusted RR 2\u00b726, 95 per cent c.i. 1\u00b737 to 3\u00b771). No statistically significant association was found between obesity and mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Being underweight was associated with increased mortality in patients with PPU, whereas being overweight or obese was neither protective nor an adverse prognostic factor.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.9529","type":"journal-article","created":{"date-parts":[[2014,5,15]],"date-time":"2014-05-15T13:10:49Z","timestamp":1400159449000},"page":"993-999","source":"Crossref","is-referenced-by-count":33,"title":["Influence of body mass index on mortality after surgery for perforated peptic ulcer"],"prefix":"10.1093","volume":"101","author":[{"given":"D L","family":"Buck","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M H","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2014,5,15]]},"reference":[{"key":"2021031618011263500_bjs9529-bib-0001","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/BF03404221","article-title":"Body mass index and risk of cardiovascular disease, cancer and all-cause mortality","volume":"103","author":"Katzmarzyk","year":"2012","journal-title":"Can J Public Health"},{"key":"2021031618011263500_bjs9529-bib-0002","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3109\/00365521003783320","article-title":"Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review","volume":"45","author":"M\u00f8ller","year":"2010","journal-title":"Scand J Gastroenterol"},{"key":"2021031618011263500_bjs9529-bib-0003","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","article-title":"Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies","volume":"373","author":"Prospective Studies Collaboration","year":"2009","journal-title":"Lancet"},{"key":"2021031618011263500_bjs9529-bib-0004","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1001\/archinte.165.1.55","article-title":"The obesity paradox: body mass index and outcomes in patients with heart failure","volume":"165","author":"Curtis","year":"2005","journal-title":"Arch Intern Med"},{"key":"2021031618011263500_bjs9529-bib-0005","doi-asserted-by":"crossref","first-page":"R72","DOI":"10.1186\/cc12680","article-title":"Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study","volume":"17","author":"Arabi","year":"2013","journal-title":"Crit Care"},{"key":"2021031618011263500_bjs9529-bib-0006","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1097\/CCM.0b013e31828a2aa1","article-title":"Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study","volume":"41","author":"Pickkers","year":"2013","journal-title":"Crit Care Med"},{"key":"2021031618011263500_bjs9529-bib-0007","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/01.CCM.0000202207.87891.FC","article-title":"Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury","volume":"34","author":"O'Brien","year":"2006","journal-title":"Crit Care Med"},{"key":"2021031618011263500_bjs9529-bib-0008","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1378\/chest.123.4.1202","article-title":"Impact of body mass index on outcomes following critical care","volume":"123","author":"Tremblay","year":"2003","journal-title":"Chest"},{"key":"2021031618011263500_bjs9529-bib-0009","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/SLA.0b013e3181ad8935","article-title":"The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery","volume":"250","author":"Mullen","year":"2009","journal-title":"Ann Surg"},{"key":"2021031618011263500_bjs9529-bib-0010","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.surge.2013.02.003","article-title":"The obesity paradox in the surgical population","volume":"11","author":"Valentijn","year":"2013","journal-title":"Surgeon"},{"key":"2021031618011263500_bjs9529-bib-0011","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.amjcard.2006.04.039","article-title":"The obesity paradox: fact or fiction?","volume":"98","author":"Habbu","year":"2006","journal-title":"Am J Cardiol"},{"key":"2021031618011263500_bjs9529-bib-0012","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000323958","article-title":"Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality","volume":"84","author":"Lau","year":"2011","journal-title":"Digestion"},{"key":"2021031618011263500_bjs9529-bib-0013","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2337\/diacare.29.04.06.dc05-1748","article-title":"Diabetes and 30-day mortality from peptic ulcer bleeding and perforation: a Danish population-based cohort study","volume":"29","author":"Thomsen","year":"2006","journal-title":"Diabetes Care"},{"key":"2021031618011263500_bjs9529-bib-0014","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/00365520802307997","article-title":"Perforated peptic ulcer: how to improve outcome?","volume":"44","author":"M\u00f8ller","year":"2009","journal-title":"Scand J Gastroenterol"},{"key":"2021031618011263500_bjs9529-bib-0015","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1757-7241-21-25","article-title":"Scoring systems for outcome prediction in patients with perforated peptic ulcer","volume":"21","author":"Thorsen","year":"2013","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2021031618011263500_bjs9529-bib-0016","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0002-9610(05)81225-5","article-title":"APACHE II in emergency operations for perforated ulcers","volume":"159","author":"Schein","year":"1990","journal-title":"Am J Surg"},{"key":"2021031618011263500_bjs9529-bib-0017","first-page":"49","article-title":"A simplified prognostic scoring system for peptic ulcer perforation in developing countries","volume":"22","author":"Mishra","year":"2003","journal-title":"Indian J Gastroenterol"},{"key":"2021031618011263500_bjs9529-bib-0018","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1001\/archsurg.136.1.90","article-title":"Predicting mortality and morbidity of patients operated on for perforated peptic ulcers","volume":"136","author":"Lee","year":"2001","journal-title":"Arch Surg"},{"key":"2021031618011263500_bjs9529-bib-0019","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00423-007-0156-7","article-title":"Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer","volume":"392","author":"Ko\u00e7","year":"2007","journal-title":"Langenbecks Arch Surg"},{"key":"2021031618011263500_bjs9529-bib-0020","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1399-6576.2011.02609.x","article-title":"The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study","volume":"56","author":"M\u00f8ller","year":"2012","journal-title":"Acta Anaesthesiol Scand"},{"key":"2021031618011263500_bjs9529-bib-0021","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1002\/bjs.9368","article-title":"Strategies to improve the outcome of emergency surgery for perforated peptic ulcer","volume":"101","author":"S\u00f8reide","year":"2014","journal-title":"Br J Surg"},{"key":"2021031618011263500_bjs9529-bib-0022","first-page":"190","article-title":"Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch","volume":"23","author":"Kumar","year":"2002","journal-title":"Trop Gastroenterol"},{"key":"2021031618011263500_bjs9529-bib-0023","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"2021031618011263500_bjs9529-bib-0024","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1002\/bjs.9028","article-title":"Quality-of-care initiative in patients treated surgically for perforated peptic ulcer","volume":"100","author":"M\u00f8ller","year":"2013","journal-title":"Br J Surg"},{"key":"2021031618011263500_bjs9529-bib-0025","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1403494810387965","article-title":"The Danish Civil Registration System","volume":"39","author":"Pedersen","year":"2011","journal-title":"Scand J Public Health"},{"key":"2021031618011263500_bjs9529-bib-0026","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"2021031618011263500_bjs9529-bib-0027","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1002\/(SICI)1097-0258(19980730)17:14<1623::AID-SIM871>3.0.CO;2-S","article-title":"A simple method of sample size calculation for linear and logistic regression","volume":"17","author":"Hsieh","year":"1998","journal-title":"Stat Med"},{"key":"2021031618011263500_bjs9529-bib-0028","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S0167-5877(02)00012-0","article-title":"Calculating sample size bounds for logistic regression","volume":"54","author":"Broll","year":"2002","journal-title":"Prev Vet Med"},{"key":"2021031618011263500_bjs9529-bib-0029","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/096228029900800102","article-title":"Multiple imputation: a primer","volume":"8","author":"Schafer","year":"1999","journal-title":"Stat Methods Med Res"},{"key":"2021031618011263500_bjs9529-bib-0030","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1037\/1082-989X.7.2.147","article-title":"Missing data: our view of the state of the art","volume":"7","author":"Schafer","year":"2002","journal-title":"Psychol Methods"},{"key":"2021031618011263500_bjs9529-bib-0031","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/bjs.9175","article-title":"Surgical delay is a critical determinant of survival in perforated peptic ulcer","volume":"100","author":"Buck","year":"2013","journal-title":"Br J Surg"},{"key":"2021031618011263500_bjs9529-bib-0032","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1093\/intqhc\/mzh031","article-title":"Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project","volume":"16","author":"Mainz","year":"2004","journal-title":"Int J Qual Health Care"},{"key":"2021031618011263500_bjs9529-bib-0033","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1007\/s00134-013-2949-1","article-title":"Reporting and handling missing values in clinical studies in intensive care units","volume":"39","author":"Vesin","year":"2013","journal-title":"Intensive Care Med"},{"key":"2021031618011263500_bjs9529-bib-0034","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/j.1525-139X.2005.00074.x","article-title":"Recent advances in understanding the malnutrition\u2013inflammation\u2013cachexia syndrome in chronic kidney disease patients: What is next?","volume":"18","author":"Kalantar-Zadeh","year":"2005","journal-title":"Semin Dial"},{"key":"2021031618011263500_bjs9529-bib-0035","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1056\/NEJMoa022139","article-title":"The epidemiology of sepsis in the United States from 1979 through 2000","volume":"348","author":"Martin","year":"2003","journal-title":"N Engl J Med"},{"key":"2021031618011263500_bjs9529-bib-0036","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1016\/S0140-6736(03)13640-9","article-title":"Obesity in general elective surgery","volume":"361","author":"Dindo","year":"2003","journal-title":"Lancet"},{"key":"2021031618011263500_bjs9529-bib-0037","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/01.CCM.0000297885.60037.6E","article-title":"Effect of obesity on intensive care morbidity and mortality: a meta-analysis","volume":"36","author":"Akinnusi","year":"2008","journal-title":"Crit Care Med"},{"key":"2021031618011263500_bjs9529-bib-0038","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/bjs.8986","article-title":"Analysis of the causes and effects of delay before diagnosis using surgical mortality data","volume":"100","author":"North","year":"2013","journal-title":"Br J Surg"},{"key":"2021031618011263500_bjs9529-bib-0039","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jhin.2013.06.012","article-title":"Obesity and nosocomial infections","volume":"85","author":"Huttunen","year":"2013","journal-title":"J Hosp Infect"},{"key":"2021031618011263500_bjs9529-bib-0040","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/oxfordjournals.aje.a008733","article-title":"How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?","volume":"143","author":"Gallagher","year":"1996","journal-title":"Am J Epidemiol"},{"key":"2021031618011263500_bjs9529-bib-0041","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1038\/ijo.2008.11","article-title":"Accuracy of body mass index in diagnosing obesity in the adult general population","volume":"32","author":"Romero-Corral","year":"2008","journal-title":"Int J Obes (Lond)"},{"key":"2021031618011263500_bjs9529-bib-0042","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1210\/jc.2009-1584","article-title":"The predictive value of different measures of obesity for incident cardiovascular events and mortality","volume":"95","author":"Schneider","year":"2010","journal-title":"J Clin Endocrinol Metab"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.9529","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/101\/8\/993\/36619642\/bjs9529.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/101\/8\/993\/36619642\/bjs9529.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T14:11:32Z","timestamp":1621519892000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/101\/8\/993-999\/6138036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,5,15]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2014,5,15]]},"published-print":{"date-parts":[[2014,6,10]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.9529","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2014,7]]},"published":{"date-parts":[[2014,5,15]]}}}