Safety of Hepatic Resections in Obese Veterans

Abstract

To determine the effects of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) on outcomes after liver resection performed at Veterans Affairs medical centers. Design, Setting, and Patients: We queried the Veterans Affairs Surgical Quality Improvement Program database for liver resections (2005-2008) and grouped the patients into 5 BMI categories: normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class 1 (BMI 30.0-34.9), obese class 2 (BMI 35.0-39.9), and obese class 3 (BMI Ն40.0). Differences in risk factors and perioperative complications across groups were analyzed in univariate and multivariate analyses. Results: Of 403 patients who underwent hepatectomy, 106 (26%) were normal weight, 161 (40%) were overweight, 94 (23%) were obese class 1, 31 (8%) were obese class 2, and 11 (3%) were obese class 3. Among these groups, higher BMI was associated with increased rates of hypertension (52%, 61%, 77%, 77%, and 73%, respectively; P=.002) and diabetes (18%, 27%, 36%, 39%, and 45%, respectively; P =.04) and lower incidence of smokers (53%, 35%, 30%, 16%, and 9%, respectively; PϽ.001). The BMI groups were similar in demographic characteristics and metrics correlating with preexisting liver disease. There were no differences across BMI groups in overall and specific morbidity or in length of stay. Compared with the other groups, obese class 3 patients received more blood transfusions (mean [SD], 4.3 [2.7] in obese class 3 patients vs 1.1 [0.2] in normal-weight patients; P=.02) and had a higher 30-day mortality (27% in obese class 3 patients vs 6% in normal-weight patients; P =.05). Multivariate analyses confirmed obese class 3 as an independent predictor of postoperative mortality. Conclusions: Obesity did not increase postoperative complications after liver resection in veterans. After adjusting for other clinical factors, extreme obesity (BMI Ն40.0) was an independent risk factor for increased mortality.

Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy

“…This may reflect the fact that obese people have good nutritional and physiological reserves and show enhanced inflammatory response to injury, which may counteract comorbidity and mortality among obese patients undergoing hepatectomy [ 11 , 38 ]. On the other hand, some authors have reported that obesity worsens the prognosis of HCC patients [ 9 , 10 ]. Further studies are needed to clarify these differences before definitive conclusions can be made.…”

Laparoscopic Liver Resection in Obese Patients

“…Previous reports have shown that obesity is not an independent risk factor in laparoscopic colorectal surgery [28–32]. However, Saunders et al [33] showed that a high level of obesity (BMI ≥ 40.0) was an independent risk factor for higher transfusion rates and increased mortality. They suggested that this information should be considered when discussing alternative therapies (e.g., ablation) in patients with extreme obesity and malignant liver neoplasms.…”

Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

“…It is well established that obese patients as well as overweight patients have more co-morbidities, such as cardiovascular disease and diabetes mellitus[3], [11], [12], [25]. In addition, two studies with large samples earlier indicated that obese and overweight patients did increase workload for surgeons by adding operating time or length of hospital stays[2], [26].…”

“…The accompanying chronic liver disease in HBV-related HCC patients may cause more severe complications than in other patients[30]. Second, the absence of unified standards in reported complications hampered proper evaluation of the surgery results in several large-sample studies[2], [8], [11], [25]–[27]. Thirdly, for liver resection in HCC patients, most cohorts[12]–[14] had a small sample of patients and the statistical power was limited.…”