RESUMO
BACKGROUND: The global burden of obesity has reached epidemic proportions, placing great strain on the North American healthcare system. We designed a retrospective cohort database study comparing postoperative morbidity and healthcare resource utilization between patients living with and without obesity undergoing surgery for colorectal cancer. METHODS: Adult patients undergoing resection for colorectal cancer were identified from the 2015 to 2019 National Inpatient Sample database. Patients were stratified according to obesity status (i.e., body mass index of 30 kg/m2). Propensity score matching (PSM) with 1:1 nearest-neighbour matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, length of stay, total admission healthcare cost, and post-discharge disposition. McNemar's and Wilcoxon matched pairs signed rank tests were performed. RESULTS: After PSM, 7565 non-obese and 7565 obese patients were included. Patients with obesity had a 10% increase in relative risk of overall in-hospital postoperative morbidity (23.1% versus 25.6%, P = 0.0015) and a $4564 increase in hospitalization cost ($70 248 USD versus $74 812 USD, P = 0.0004). Patients with obesity were more likely to require post-operative ICU admission (5.0% versus 8.0%, P < 0.0001) and less likely to be discharged home after their index operation (68.3% versus 64.2%, P = 0.0022). CONCLUSION: Patients with obesity undergoing surgery for colorectal cancer may be at an increased risk of in-hospital postoperative morbidity. They may also be more likely to have increased hospitalization costs, post-operative ICU admissions, and to not be discharged directly home. Preoperative optimization via weight loss strategies should be further explored.
RESUMO
The objective of this study was to evaluate the prevalence of burnout among medical residents in and assess the influence of certain demographic factors. The residents were asked to classify their level of burnout (according to one out of five levels of burnout) using their own definition of burnout. This survey was undertaken away from any examination time and confidentially ascertained. The frequency of burnout and itself level were calculated and compared between genders and year of training using the Chi-square. Eighty-two residents responded to the survey (100% of attendees and 91.1% of all residents in the department); 74.2% were male and 25.8% of female, 38.7% were in their 1st year of training, 24.2% in their 2nd year, 29.0% in their 3rd year, and 8.1% in their 4th year. The overall burnout frequency was 41.9% (29% with moderate burnout, and 12.9% with severe burnout). Overall twice as many female residents had burnout than males (P = 0.017). The prevalence of "moderate burnout" among males and females was 19.8% and 56.3%, respectively. However, no difference between males and females was seen in the "severe burnout" category (13% and 12.5%, respectively). The overall burnout rate was the lowest in the 1st year of training (33.3%) and the highest in the last (60%) but with no statistical significance (P = 0.4). Whereas 2/3rd of the male residents had no burnout, only 1/3rd one their female counterparts had no burnout (P = 0.017). Conversely, the prevalence of "moderate burnout" among males and females was 19.8% and 56.3%, respectively (P = 0.002). However, no difference between males and females was seen in the "severe burnout" category (13% and 12.5%, respectively. In conclusion, 50% of the residents had burnout which was significantly more prevalent in females. The rate of burnout is the highest in the last year of training and the lowest in the 1st year.