{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:21:17Z","timestamp":1793467277101,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,7,26]],"date-time":"2013-07-26T00:00:00Z","timestamp":1374796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>\nThe obesity paradox has been demonstrated postoperatively in several surgical populations, but only a few studies have reported long\u2010term survival. This study evaluates the presence of the obesity paradox in a general surgery population, reporting both postoperative and long\u2010term survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 10,427 patients scheduled for elective, noncardiac surgery. Patients were classified as underweight (body mass index (BMI) &lt; 18.5\u00a0kg\/m<jats:sup>2<\/jats:sup>); normal weight (BMI 18.5\u201324.9\u00a0kg\/m<jats:sup>2<\/jats:sup>); overweight (BMI 25.0\u201329.9\u00a0kg\/m<jats:sup>2<\/jats:sup>); obesity class I (BMI 30.0\u201334.9\u00a0kg\/m<jats:sup>2<\/jats:sup>); obesity class II (BMI 35.0\u201339.9\u00a0kg\/m<jats:sup>2<\/jats:sup>); and obesity class III (BMI \u2265 40.0\u00a0kg\/m<jats:sup>2<\/jats:sup>). Study endpoints were 30\u2010day postoperative and long\u2010term mortality, including cause\u2010specific mortality. Multivariable analyses were used to evaluate mortality risks for each BMI category.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within 30\u00a0days after surgery, 353 (3.4 %) patients died. Overweight was the only category associated with postoperative mortality, showing improved survival [odds ratio 0.7; 95 % confidence interval (CI) 0.6\u20130.9]. During the long\u2010term follow\u2010up 4,884 (47 %) patients died. Underweight patients had the highest mortality risk [hazard ratio (HR) 1.4; 95 % CI 1.2\u20131.6), particularly due to high cancer\u2010related deaths. In contrast, overweight and obese patients demonstrated improved survival (overweight: HR 0.8, 95 % CI 0.8\u20130.9; obesity class I: HR 0.7, 95 % CI 0.7\u20130.8; obesity class II: HR 0.7, 95 % CI 0.6\u20130.9; obesity class III: HR 0.7, 95 % CI 0.5\u20131.0), mainly because of a strongly reduced risk of cancer\u2010related death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this surgical population the obesity paradox was validated at the long term, mainly because of decreased cancer\u2010related deaths among obese patients.\n<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-013-2162-y","type":"journal-article","created":{"date-parts":[[2013,7,25]],"date-time":"2013-07-25T17:44:02Z","timestamp":1374774242000},"page":"2561-2568","source":"Crossref","is-referenced-by-count":41,"title":["Impact of Obesity on Postoperative and Long\u2010term Outcomes in a General Surgery Population: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"37","author":[{"given":"Tabita M.","family":"Valentijn","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Erasmus University Medical Center Room H\u20101273, P.O. Box 2040 3000 CA Rotterdam The Netherlands"},{"name":"Department of Vascular Surgery Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Galal","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus University Medical Center Room H\u20101273, P.O. Box 2040 3000 CA Rotterdam The Netherlands"},{"name":"Department of Vascular Surgery Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne E.","family":"Hoeks","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus University Medical Center Room H\u20101273, P.O. Box 2040 3000 CA Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvette R.","family":"van Gestel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus University Medical Center Room H\u20101273, P.O. Box 2040 3000 CA Rotterdam The Netherlands"},{"name":"Eindhoven Cancer Registry Comprehensive Cancer Center South (IKZ) Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hence J.","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Stolker","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus University Medical Center Room H\u20101273, P.O. Box 2040 3000 CA Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,7,26]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.13.1549"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.2014"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u20108\u2010200"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000161044.20857.24"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(05)67483\u20101"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.15.1861"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.02.014"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(06)69251\u20109"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000095319"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08\u20100418"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2007.36"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010008\u20109990\u20102"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181ad8935"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.08.052"},{"key":"e_1_2_7_16_2","first-page":"1","article-title":"Obesity: preventing and managing the global epidemic\u07ddreport of a WHO consultation","volume":"894","author":"World Health Organization","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp337"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.100.10.1043"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199908053410607"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e3283499e3b"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.07.018"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(99)04021\u20100"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(08)60269\u2010X"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/1758\u20105996\u20103\u201012"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010009\u20100645\u20108"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021423"}],"updated-by":[{"DOI":"10.1007\/s00268-013-2218-z","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T00:00:00Z","timestamp":1377216000000}}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-013-2162-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-013-2162-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-013-2162-y","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T23:30:37Z","timestamp":1703633437000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-013-2162-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,26]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2013,11]]}},"alternative-id":["10.1007\/s00268-013-2162-y"],"URL":"https:\/\/doi.org\/10.1007\/s00268-013-2162-y","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7,26]]}}}