Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies.
Berardi, Giammauro Kingham, T Peter Zhang, Wanguang Syn, Nicholas L Koh, Ye-Xin Jaber, Bashar Aghayan, Davit L Siow, Tiing Foong Lim, Chetana Scatton, Olivier
Berardi, Giammauro
Kingham, T Peter
Zhang, Wanguang
Syn, Nicholas L
Koh, Ye-Xin
Jaber, Bashar
Aghayan, Davit L
Siow, Tiing Foong
Lim, Chetana
Scatton, Olivier
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2023-06-03
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Abstract
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.
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Berardi G, Kingham TP, Zhang W, Syn NL, Koh YX, Jaber B, Aghayan DL, Siow TF, Lim C, Scatton O, Herman P, Coelho FF, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Gastaca M, Vivarelli M, Giuliante F, Dalla Valle B, Ruzzenente A, Yong CC, Chen Z, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Dalla Valle R, Boggi U, Geller D, Belli A, Memeo R, Gruttadauria S, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Schmelzle M, Pratschke J, Lai ECH, Chong CCN, Meurs J, D'Hondt M, Monden K, Lopez-Ben S, Liu Q, Liu R, Ferrero A, Ettorre GM, Cipriani F, Pascual F, Cherqui D, Zheng J, Liang X, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Kato Y, Sugioka A, D'Silva M, Han HS, Nghia PP, Long TCD, Edwin B, Fuks D, Abu Hilal M, Aldrighetti L, Chen KH, Goh BKP; International robotic and laparoscopic liver resection study group investigators. Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies. Surgery. 2023 Aug;174(2):259-267. doi: 10.1016/j.surg.2023.04.016. Epub 2023 Jun 3. PMID: 37271685.
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