Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
25
01
2023
revised:
19
03
2023
accepted:
09
04
2023
medline:
25
7
2023
pubmed:
5
6
2023
entrez:
4
6
2023
Statut:
ppublish
Résumé
Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies. This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized. A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most perioperative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P < .001), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P = .009) in obese, overweight, normal weight, and underweight patients, respectively (P < .001). However, postoperative major morbidity demonstrated a "U"-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients. Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures.
Sections du résumé
BACKGROUND
Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies.
METHODS
This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized.
RESULTS
A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most perioperative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P < .001), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P = .009) in obese, overweight, normal weight, and underweight patients, respectively (P < .001). However, postoperative major morbidity demonstrated a "U"-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients.
CONCLUSION
Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures.
Identifiants
pubmed: 37271685
pii: S0039-6060(23)00191-5
doi: 10.1016/j.surg.2023.04.016
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
259-267Investigateurs
Mikel Prieto
(M)
Celine De Meyere
(C)
Kit-Fai Lee
(KF)
Kelvin K Ng
(KK)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Masayuki Kojima
(M)
Jaime Arthur Pirola Kruger
(JAP)
Victor Lopez-Lopez
(V)
Margarida Casellas I Robert
(MCI)
Roberto Montalti
(R)
Mariano Giglio
(M)
Boram Lee
(B)
Hao-Ping Wang
(HP)
Mansour Saleh
(M)
Shian Yu
(S)
Simone Vani
(S)
Francesco Ardito
(F)
Ugo Giustizieri
(U)
Davide Citterio
(D)
Federico Mocchegiani
(F)
Marco Colasanti
(M)
Yoelimar Guzmán
(Y)
Kevin P Labadie
(KP)
Maria Conticchio
(M)
Epameinondas Dogeas
(E)
Emanuele F Kauffmann
(EF)
Mario Giuffrida
(M)
Daniele Sommacale
(D)
Alexis Laurent
(A)
Paolo Magistri
(P)
Kohei Mishima
(K)
Felix Krenzien
(F)
Prashant Kadam
(P)
Eric C H Lai
(ECH)
Jacob Ghotbi
(J)
Åsmund Avdem Fretland
(ÅA)
Fabio Forchino
(F)
Alessandro Mazzotta
(A)
Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.