Impact of Obesity on Perioperative Morbidity and Mortality after Pancreaticoduodenectomy

Williams, Timothy K.; Rosato, Ernest L.; Kennedy, Eugene P.; Chojnacki, Karen A.; Andrel, Jocelyn; Hyslop, Terry; Doria, Cataldo; Sauter, Patricia K.; Bloom, Jordan; Yeo, Charles J.; Berger, Adam C.

doi:10.1016/j.jamcollsurg.2008.10.019

« Previous Next »Journal of the American College of Surgeons
Volume 208, Issue 2 , Pages 210-217, February 2009

Impact of Obesity on Perioperative Morbidity and Mortality after Pancreaticoduodenectomy

Presented in part at the Meeting of the Pancreas Club, Washington, DC, 2007, and the 3^rd Academic Surgical Congress, Huntington Beach, CA, 2008.

Timothy K. Williams, MD
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Ernest L. Rosato, MD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Eugene P. Kennedy, MD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Karen A. Chojnacki, MD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Jocelyn Andrel, MSPH
- Division of Biostatistics, Kimmel Cancer Center, Philadelphia, PA
Terry Hyslop, PhD
- Division of Biostatistics, Kimmel Cancer Center, Philadelphia, PA
Cataldo Doria, MD, PhD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Patricia K. Sauter, CRNP
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Jordan Bloom, BS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Charles J. Yeo, MD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
Adam C. Berger, MD, FACS
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
- Correspondence address: Adam C Berger, MD, Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, 1100 Walnut St, MOB, Ste 500, Philadelphia, PA 19107

Received 6 June 2008; received in revised form 8 October 2008; accepted 8 October 2008. published online 18 December 2008.

Background

Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was to determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD).

Study Design

Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital, of whom 240 had complete data, including body mass index (BMI; calculated as kg/m²) for analysis. Data on BMI, preoperative parameters, operative details, and postoperative course were collected. Patients were categorized as obese (BMI ≥ 30), overweight (BMI ≥ 25 and < 30), or normal weight (BMI < 25). Complications were graded according to previously published scales. Other end points included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models.

Results

There were 103 (42.9%) normal-weight, 71 (29.6%) overweight, and 66 (27.5%) obese patients. There were 5 perioperative deaths (2.1%), with no differences across BMI categories. A significant difference in median operative duration and blood loss between obese and normal-weight patients was identified (439 versus 362.5 minutes, p = 0.0004; 650 versus 500 mL, p = 0.0139). In addition, median length of stay was significantly longer for BMI (9.5 versus 8 days, p = 0.095). Although there were no significant differences in superficial wound infections, obese patients did have an increased rate of serious complications compared with normal-weight patients (24.2% versus 13.6%, respectively; p = 0.10).

Conclusions

Obese patients undergoing PD have a substantially increased blood loss and longer operative time but do not have a substantially increased length of postoperative hospital stay or rate of serious complications. These findings should be considered when assessing patients for operation and when counseling patients about operative risk, but they do not preclude obese individuals from undergoing definitive pancreatic operations.

Abbreviations and Acronyms: ASA, American Society of Anesthesiologists, BMI, body mass index, OR, odds ratio, PD, pancreaticoduodenectomy, PPPD, pylorus-preserving pancreaticoduodenectomy