Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: A national cohort study

Abstract

Background The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Objectives This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP‐related complications in patients who underwent ERCP. Methods We conducted a US population‐based retrospective cohort study using the Nationwide Readmissions Databases (2013–2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in‐hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP‐related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders. Results Patients with morbid obesity, as compared to normal‐weight patients, were associated with a significantly higher in‐hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23–25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14–7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP‐related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients. Conclusions Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP.

Is Body Mass Index a Risk Factor in Patients Developing Post-ERCP Complications?

“…In a study conducted by Divyangkumar et al with 38,557 patients, no signi cant difference was found in terms of post-ERCP perforation between obese and non-obese patients [12]. In another study conducted by Chen et al, no signi cant difference was found between BMI groups in terms of post-ERCP perforation [13]. We also found similar results in our study, consistent with the literature.…”

“…There was no statistically signi cant difference in hospital stay among patients based on BMI groups in our study (p > 0.05). In a study by Chen et al, there was no signi cant difference in hospital stay between normal weight and obese patients, while statistically signi cant longer hospital stay was found in the morbidly obese group [13]. The exclusion of patients in the morbidly obese group in our study may have contributed to this difference.…”

“…In pairwise comparisons conducted to identify the source of this difference, it was found that CCI values in the overweight group were signi cantly higher than those in the normal weight group (p = 0.008; p < 0.01). Chen et al also reported higher CCI values in patients with obesity and morbid obesity who developed post-ERCP complications compared to the normal weight group in their study [13]. In a study comparing obese and non-obese patients conducted by Afolabi et al, it was found that obese patients had more comorbidities, leading to a higher Charlson Comorbidity Index (CCI) value [16].…”

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