Courtney M Lattimore1, William J Kane1, Florence E Turrentine1, Victor M Zaydfudim2. 1. Department of Surgery, University of Virginia, Charlottesville, VA; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, USA. 2. Department of Surgery, University of Virginia, Charlottesville, VA; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, USA. Electronic address: vz8h@virginia.edu.
Abstract
BACKGROUND: The impact of obesity on postoperative outcomes after pancreatoduodenectomy remains insufficiently studied. METHODS: All pancreatoduodenectomy patients were abstracted from the 2014 to 2018 American College of Surgeons National Surgical Quality Improvement Program data sets and were stratified into the following 3 body mass index categories: non-obese (body mass index 18.5-29.9), class 1/2 obesity (body mass index 30-39.9), and class 3 severe obesity (body mass index ≥ 40). Analyses tested associations between patient factors and four 30-day postoperative outcomes: mortality, composite morbidity, delayed gastric emptying, and postoperative pancreatic fistula. Multivariable logistic regression models tested independent associations between patient factors and these 4 outcome measures. RESULTS: A total of 16,823 patients were included in the study: 12,234 (72.7%) non-obese, 4,030 (24%) obese, and 559 (3.3%) with severe obesity. Bivariable analyses demonstrated significant associations between obesity, severe obesity, and greater proportions of numerous preoperative comorbidities as well as a greater likelihood of postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, composite morbidity, and mortality (all P ≤ .001). After adjusting for significant covariates, obesity was independently associated with postoperative pancreatic fistula (odds ratio 1.49, 95% confidence interval: 1.33-1.67, P < .001), delayed gastric emptying (odds ratio 1.16, 95% confidence interval: 1.05-1.28, P = .004), composite morbidity (odds ratio 1.28, 95% confidence interval: 1.18-1.38, P < .001), and mortality (odds ratio 1.79, 95% confidence interval: 1.36-2.36, P < .001). CONCLUSION: Obesity and severe obesity are significantly associated with worse short-term outcomes after pancreatoduodenectomy. Preoperative considerations, such as weight management strategies during individualized treatment planning, could improve outcomes in this population.
BACKGROUND: The impact of obesity on postoperative outcomes after pancreatoduodenectomy remains insufficiently studied. METHODS: All pancreatoduodenectomy patients were abstracted from the 2014 to 2018 American College of Surgeons National Surgical Quality Improvement Program data sets and were stratified into the following 3 body mass index categories: non-obese (body mass index 18.5-29.9), class 1/2 obesity (body mass index 30-39.9), and class 3 severe obesity (body mass index ≥ 40). Analyses tested associations between patient factors and four 30-day postoperative outcomes: mortality, composite morbidity, delayed gastric emptying, and postoperative pancreatic fistula. Multivariable logistic regression models tested independent associations between patient factors and these 4 outcome measures. RESULTS: A total of 16,823 patients were included in the study: 12,234 (72.7%) non-obese, 4,030 (24%) obese, and 559 (3.3%) with severe obesity. Bivariable analyses demonstrated significant associations between obesity, severe obesity, and greater proportions of numerous preoperative comorbidities as well as a greater likelihood of postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, composite morbidity, and mortality (all P ≤ .001). After adjusting for significant covariates, obesity was independently associated with postoperative pancreatic fistula (odds ratio 1.49, 95% confidence interval: 1.33-1.67, P < .001), delayed gastric emptying (odds ratio 1.16, 95% confidence interval: 1.05-1.28, P = .004), composite morbidity (odds ratio 1.28, 95% confidence interval: 1.18-1.38, P < .001), and mortality (odds ratio 1.79, 95% confidence interval: 1.36-2.36, P < .001). CONCLUSION: Obesity and severe obesity are significantly associated with worse short-term outcomes after pancreatoduodenectomy. Preoperative considerations, such as weight management strategies during individualized treatment planning, could improve outcomes in this population.
Authors: Jamie R Robinson; Paula Marincola; Julia Shelton; Nipun B Merchant; Kamran Idrees; Alexander A Parikh Journal: HPB (Oxford) Date: 2015-02-28 Impact factor: 3.647
Authors: Michael J Hughes; Rosie J Hackney; Peter J Lamb; Stephen J Wigmore; D A Christopher Deans; Richard J E Skipworth Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Michael G House; Yuman Fong; Dean J Arnaoutakis; Rohit Sharma; Corinne B Winston; Mladjan Protic; Mithat Gonen; Sara H Olson; Robert C Kurtz; Murray F Brennan; Peter J Allen Journal: J Gastrointest Surg Date: 2007-12-01 Impact factor: 3.452
Authors: John T Mullen; Daniel L Davenport; Matthew M Hutter; Patrick W Hosokawa; William G Henderson; Shukri F Khuri; Donald W Moorman Journal: Ann Surg Oncol Date: 2008-06-12 Impact factor: 5.344
Authors: Richard S Swanson; Christopher M Pezzi; Katherine Mallin; Ashley M Loomis; David P Winchester Journal: Ann Surg Oncol Date: 2014-09-05 Impact factor: 5.344
Authors: Matthew Benns; Charles Woodall; Charles Scoggins; Kelly McMasters; Robert Martin Journal: Ann Surg Oncol Date: 2009-06-26 Impact factor: 5.344