Obesity and its implications for morbidity and mortality after cholecystectomy: A matched NSQIP analysis

Toms Augustin; Maitham A Moslim; Stacy Brethauer; Ali Aminian; Matthew Kroh; Eric Schneider; R Matthew Walsh

doi:10.1016/j.amjsurg.2016.11.037

Obesity and its implications for morbidity and mortality after cholecystectomy: A matched NSQIP analysis

Am J Surg. 2017 Mar;213(3):539-543. doi: 10.1016/j.amjsurg.2016.11.037. Epub 2017 Jan 26.

Authors

Toms Augustin¹, Maitham A Moslim², Stacy Brethauer³, Ali Aminian⁴, Matthew Kroh⁵, Eric Schneider⁶, R Matthew Walsh⁷

Affiliations

¹ Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: augustt@ccf.org.
² Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: moslimm@ccf.org.
³ Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: brethas@ccf.org.
⁴ Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: aminiaa@ccf.org.
⁵ Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: krohm@ccf.org.
⁶ Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, 75 Francis St, Boston, MA, USA. Electronic address: eschnei1@jhmi.edu.
⁷ Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: walshm@ccf.org.

PMID: 28237044
DOI: 10.1016/j.amjsurg.2016.11.037

Abstract

Background: The risks from super obesity (SO) following cholecystectomy have not been studied.

Methods: NSQIP analysis of patients undergoing cholecystectomy from 2005 to 2011. Non-obese (NO) patients (BMI 18.5-30) were matched 1:1 by age, sex, race and comorbidities to morbidly obese (MO) (BMI 35-50), and separately to SO (BMI≥50) individuals. Clavien 4 complications and 30-day mortality were compared.

Results: 13780 MO and 1410 SO patients were matched to NO patients. Obese patients were more likely to present with chronic (CC) rather than acute cholecystitis (AC). Compared to NO patients, Clavien 4 complications were significantly increased among SO patients overall especially with AC where rate of open surgery was significantly higher.

Conclusion: SO patients have an increased risk of serious morbidity after cholecystectomy especially with AC where rate of open surgery remains high. Aggressive recommendation for cholecystectomy to reduce presentation with AC and increase likelihood for laparoscopic surgery may be beneficial in SO patients.

Keywords: Cholecystectomy; Laparoscopy; Morbid-obesity; Mortality; NSQIP; Serious complications; Super-obesity.

MeSH terms

Adult
Body Mass Index
Cholecystectomy / adverse effects*
Cholecystectomy, Laparoscopic / adverse effects
Cholecystectomy, Laparoscopic / statistics & numerical data
Cholecystitis / surgery*
Chronic Disease
Comorbidity
Female
Humans
Male
Matched-Pair Analysis
Middle Aged
Obesity, Morbid / complications*
Postoperative Complications
Retrospective Studies
United States