Obesity Does Not Increase Complications Following Pancreatic Surgery

Balentine, Courtney J.; Enriquez, J.; Cruz, Guillermina; Hodges, Sally E.; Bansal, Vivek; Jo, Eunji; Ahern, Charlotte H.; Sansgiry, Shubhada; Petersen, Nancy J.; Silberfein, Eric J.; Brunicardi, F. Charles; Berger, David H.; Fisher, William E.

doi:10.1016/j.jss.2011.03.048

Cited by 24 publications

(7 citation statements)

References 11 publications

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“…The role of obesity as a risk factor for postoperative complications following pancreatic surgery has been long debated; some studies pointed out how obesity was associated with increased postoperative morbidity [28, 29], but this finding was questioned by other investigators [30, 31]. The impact of visceral adiposity on postoperative complications has been recognized in past imaging-based studies [32], and recently, the association of visceral obesity with sarcopenia on automated preoperative imaging analysis has been proven to be a relevant indicator of increased risk of perioperative morbidity and mortality after pancreatic surgery [5, 8-10, 24, 25, 33].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

et al. 2020

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Background: Despite that mortality following pancreatoduodenectomy (PD) has gradually dropped during the past few decades, the incidence of postoperative complications remains high, ranging from 30–60%. Many studies have been focused on identification of perioperative risk factors for morbidity, and in recent years, sarcopenia has been pointed out as a valid predictor of postoperative complication. Materials and methods: Perioperative data from 110 consecutive patients who underwent PD were retrieved, and the presence of sarcopenia was assessed by the measurement of Hounsfield unit average calculation on preoperative CT scans. Postoperative complications were graded according to Clavien-Dindo classification, and the morbidity burden was assessed by comprehensive complication index (CCI) calculation. Results: Sarcopenia was associated with advanced age (72 vs. 66 years; p = 0.014) and lower preoperative albumin levels (3.5 vs. 3.7 g/dL; p = 0.010); it represented an independent risk factor for clinically relevant complications (relative risk: 1.71; p = 0.015) and was related to a higher rate of Grade C postoperative pancreatic fistula (50.0 vs. 11.4%; p = 0.005) and a higher CCI (47.6 vs. 29.6; p = 0.001). Conclusions: Sarcopenia represents a valid indicator of increased morbidity risk and may play a central role in preoperative risk stratification, allowing the selection of patients who may benefit from prehabilitation programs.

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Section: Discussionmentioning

confidence: 99%

The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

et al. 2020

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“…The literature regarding post-operative respiratory infections is also varied with morbid obesity having been associated with respiratory infection amongst elderly patients undergoing hip and knee surgery 50,54 and obesity having been associated with increasing the risk of pulmonary complications in other surgeries 44,52,55 patients; whilst other studies have observed no such associations 57 . This inconsistency is perhaps unsurprising with many studies being small and investigating multiple end-points thereby being underpowered to detect significant differences in these rarer complications.…”

Section: Discussionmentioning

confidence: 99%

The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery

Wallace

Judge

Prieto-Alhambra

et al. 2014

Osteoarthritis and Cartilage

100

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Whilst an increased risk of wound infection and DVT/PE was observed amongst obese patients, absolute risks remain low and no such association was observed for MI, stroke and mortality. However this is a selected cohort (eligible for surgery according to judgement of NHS GPs and surgeons) and as such these results do not advocate surgery be given without consideration of BMI, but indicate that universal denial of surgery based on BMI is unwarranted.

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“…Prior studies investigating the relationship between obesity or BMI and CR-POPF have yielded conflicting results. [14][15][16] We examined this relationship using our institutional database and hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC).…”

mentioning

confidence: 99%

Rising BMI is Associated with Increased Rate of Clinically Relevant Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Adenocarcinoma

Zhou

Drake

Deneve

et al. 2019

The American Surgeon™

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Clinically relevant pancreatic fistula (CR-POPF), after distal pancreatectomy (DP), remains a clinical challenge. Prior studies investigating the relationship between BMI and CR-POPF have yielded conflicting results. We hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Patients who underwent DP for PDAC at a single institution from 2006 to 2018 were retrospectively reviewed. A CR-POPF was defined as International Study Group of Pancreatic Surgery (ISGPS) grade B or C fistula. Uni- and multivariable logistic regression analysis assessed factors associated with CR-POPF after DP. Seventy-eight patients met the inclusion criteria, 51 per cent were female, 51 per cent were white, and the average age was 59 ± 15 years. The median BMI was 26 (IQR 24–29). Of all, 19 per cent (n = 15) of patients had a CR-POPF. With a mean follow-up of 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with survival ( P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (odds ratio (OR) = 0.95, P = 0.015). Increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). On multivariate analysis, after controlling for multiple factors, BMI (OR = 1.12, P = 0.035) was the only factor associated with the development of a CR-POPF, whereas older age (OR = 0.94, P < 0.001) was slightly protective. Increasing BMI is associated with an increased risk of CR-POPF after DP for PDAC. These findings should be considered during preoperative counseling. Efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI.

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Obesity Does Not Increase Complications Following Pancreatic Surgery

Cited by 24 publications

References 11 publications

The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery

Rising BMI is Associated with Increased Rate of Clinically Relevant Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Adenocarcinoma

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