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 3rd Academic Surgical Congress, Huntington Beach, CA, 2008.

  • Timothy K. Williams, MD

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Ernest L. Rosato, MD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Eugene P. Kennedy, MD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Karen A. Chojnacki, MD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Jocelyn Andrel, MSPH

      Affiliations

    • Division of Biostatistics, Kimmel Cancer Center, Philadelphia, PA
  • ,
  • Terry Hyslop, PhD

      Affiliations

    • Division of Biostatistics, Kimmel Cancer Center, Philadelphia, PA
  • ,
  • Cataldo Doria, MD, PhD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Patricia K. Sauter, CRNP

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Jordan Bloom, BS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Charles J. Yeo, MD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
  • ,
  • Adam C. Berger, MD, FACS

      Affiliations

    • Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA
    • Corresponding Author InformationCorrespondence 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 ,Revised 8 October 2008 ,Accepted 8 October 2008.

References 

  1. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–257discussion 257−260
  2. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–278
  3. Winter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2007;204:1029–1036discussion 1037−1028
  4. Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery. 2006;139:591–598
  5. Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951–959
  6. Veerman JL, Barendregt JJ, van Beeck EF, et al. Stemming the obesity epidemic: a tantalizing prospect. Obesity. 2007;15:2365–2370
  7. Patel AV, Rodriguez C, Bernstein L, et al. Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort. Cancer Epidemiol Biomarkers Prev. 2005;14:459–466
  8. Villavicencio MA, Sundt TM, Daly RC, et al. Cardiac surgery in patients with body mass index of 50 or greater. Ann Thorac Surg. 2007;83:1403–1411
  9. Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg. 2000;179:275–281
  10. Thomas EJ, Goldman L, Mangione CM, et al. Body mass index as a correlate of postoperative complications and resource utilization. Am J Med. 1997;102:277–283
  11. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg. 1997;185:593–603
  12. Kennedy EP, Rosato EL, Sauter PK, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution—the first step in multidisciplinary team building. J Am Coll Surg. 2007;204:917–923discussion 923−914
  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213
  14. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–526
  15. Yamada H, Kojima K, Inokuchi M, et al. Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy—comparison with open distal gastrectomy. J Gastrointest Surg. 2008;12:997–1004
  16. Heinberg EM, Crawford BL, Weitzen SH, Bonilla DJ. Total laparoscopic hysterectomy in obese versus nonobese patients. Obstet Gynecol. 2004;103:674–680
  17. Scipione CN, Chang AC, Pickens A, et al. Transhiatal esophagectomy in the profoundly obese: implications and experience. Ann Thorac Surg. 2007;84:376–382discussion 383
  18. Turna B, Frota R, Kamoi K, et al. Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J Urol. 2008;179:1289–1294discussion 1294−1285
  19. Guest JD, Vanni S, Silbert L. Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J. 2004;4:130–137
  20. Surgenor SD, DeFoe GR, Fillinger MP, et al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation. 2006;114:I43–I48
  21. Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth. 2008;11:15–19
  22. Mutsaerts E, Zoetmulder F, Hart A, van Coevorden F. Perioperative morbidity in hepatic surgery. Hepatogastroenterology. 2007;54:458–462
  23. Nagino M, Kamiya J, Arai T, et al. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–155
  24. Hawn MT, Bian J, Leeth RR, et al. Impact of obesity on resource utilization for general surgical procedures. Ann Surg. 2005;241:821–826discussion 826−828
  25. Webster C, Neumayer L, Smout R, et al. Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res. 2003;109:130–137
  26. Klasen J, Junger A, Hartmann B, et al. Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery. Obes Surg. 2004;14:275–281
  27. Kessler S, Kafer W. Overweight and obesity: two predictors for worse early outcome in total hip replacement?. Obesity. 2007;15:2840–2845
  28. Grobmyer SR, Pieracci FM, Allen PJ, et al. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–364
  29. Pessaux P, Msika S, Atalla D, et al. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg. 2003;138:314–324
  30. Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet. 2003;361:2032–2035
  31. Kodera Y, Ito S, Yamamura Y, et al. Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology. 2004;51:1225–1228

 Disclosure Information: Nothing to disclose.

PII: S1072-7515(08)01533-0

doi: 10.1016/j.jamcollsurg.2008.10.019

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