C. J. Neylan1, D. T. Dempsey1, R. R. Kelz1, G. C. Karakousis1, K. Lee1, N. N. Williams1, A. Furukawa1, M. G. Peters1, K. R. Dumon1 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: Obesity is a risk factor for cholelithiasis and subsequent cholecystitis. Cholecystectomy remains the mainstay of treatment for acute cholecystitis. Little is known about the risk of obesity on outcomes following cholecystectomy for acute cholecystitis. The purpose of this study was to examine the impact of obesity on the outcomes of cholecystectomy for acute cholecystitis.
Methods: Patients who underwent a cholecystectomy (laparoscopic, open, or converted) for acute cholecystitis from 2007-2013 were identified from the American College of Surgeons NSQIP database. Patients were classified into normal (BMI < 30) and obese (BMI ≥ 30) groups. Obese patients were subcategorized into the following groups: 30 ≤ BMI < 40, 40 ≤ BMI < 50, and 50 ≤ BMI. The outcomes of interest were operative time, mortality, morbidity, and post-operative length of stay. Independent multivariable logistic and linear regression models were used to examine the association between obesity and each of the outcomes of interest. A procedure was considered converted if there was a primary CPT code for a laparoscopic procedure and a secondary CPT code for an open procedure.
Results: Of 22, 808 patients included in the study, 46% were obese. After adjustment for potential confounders, obesity (BMI ≥ 30) was found to be significantly associated with prolonged operative time (defined as a procedure-specific operative time in the 90th percentile or above) (OR = 1.43, p < 0.0001) relative to normal BMI. Obesity was not significantly associated with overall morbidity, mortality, or post-operative length of stay. Subgroup analysis revealed that each obese subgroup was significantly associated with a prolonged operative time, relative to the normal BMI group. The subgroup with a BMI between 40 and 49.9 had a significantly higher mortality rate relative to the normal BMI group (OR 3.16, p = 0.003), and the subgroup with a BMI between 30 and 39.9 had significantly more thromboembolic complications (pulmonary embolism or DVT) relative to the normal BMI group (OR 1.86, p = 0.02). Among open cholecystectomies, obesity was significantly associated with prolonged operative time and increased mortality compared to a normal BMI. Among laparoscopic cholecystectomies, obesity was significantly associated with prolonged operative time but not increased mortality, relative to normal BMI. The percent of patients who received laparoscopic vs. open cholecystectomies did not vary with BMI.
Conclusion: The data suggest that cholecystectomy for acute cholecystitis is safe even in high BMI patients, and that the operation can usually be completed laparoscopically. However, certain groups of obese patients are at increased risk for postoperative morbidity or mortality.
