The impact of body mass index on outcomes after laparoscopic cholecystectomy
Background Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associa...
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| Veröffentlicht in: | Surgical endoscopy 2012-04, Vol.26 (4), p.964-969 |
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| description | Background
Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.
Methods
A retrospective chart review of 1,027 patients who underwent an attempted LC between January 2006 and December 2009 was performed. Patients were divided into five groups depending on their BMI: 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40. The primary endpoints were conversion rates, complication rates, and postoperative length of stay (LOS). Multivariate logistic regression was used to identify independent risk factors for worse outcomes.
Results
There were 211 (20.5%), 325 (31.6%), 268 (26.1%), 135 (13.1%), and 88 (8.6%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40, respectively. Seventy-three patients (7.1%) required conversion to open surgery, and 64 patients (6.2%) developed complications. The rate of conversion was similar amongst all the BMI groups (
P
= 0.366), as was the rate of complication (
P
= 0.483). Mean (±SD) postoperative LOS was 1.74 ± 3.87 days, and there was no difference between the BMI groups (
P
= 0.596). Male gender and emergent cholecystectomy were independent predictors of increased conversions and complications. Diabetes was a risk factor for conversion, whereas age >65 years was a risk factor for complications.
Conclusions
Increased BMI was not associated with worse outcomes after LC. Compared with normal weight patients, obese and even morbidly obese patients have no increased risk of conversion to open surgery, nor is there an increased risk of perioperative complications. Obese and morbidly obese patients who require a cholecystectomy should be considered in the same category as normal weight patients, and LC should be the standard of care. |
| doi_str_mv | 10.1007/s00464-011-1978-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_948896393</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2616244471</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-46db361615889fd725508995d363ef0954419951d45e620c08df89b9acf724d13</originalsourceid><addsrcrecordid>eNp9kUuLFDEUhYM4OG3rD3AjQRDd1JibR6XuUgYfAw2zGdchnYdTQ1WlTKrA_vem6dYBQVfhku-c-ziEvAJ2BYzpD4Ux2cqGATSAumvUE7IBKXjDOXRPyYahYA3XKC_J81IeWMUR1DNyyXnVoIIN2d3dB9qPs3ULTZHukz_Q0ZZC-8mHnzRNNK2LS2Mo1MYlZDrY2eZUXJp7R919GoI7lCW4JY2HF-Qi2qGEl-d3S759_nR3_bXZ3X65uf64a5xEXBrZ-r1ooQXVdRi95kqxDlF50YoQGSopoZbgpQotZ451Pna4R-ui5tKD2JJ3J985px9rKIsZ--LCMNgppLUYlNW4FSgq-f6_JHSohda8slvy5i_0Ia15qnsYFLIVUHtXCE6QqzcoOUQz5360-WCAmWMm5pSJqfc1x0yMqprXZ-N1Pwb_R_E7hAq8PQO2ODvEbCfXl0dO6bqNPE7IT1ypX9P3kB8n_Hf3X0buoYU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>934631724</pqid></control><display><type>article</type><title>The impact of body mass index on outcomes after laparoscopic cholecystectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Farkas, Daniel T. ; Moradi, Dovid ; Moaddel, David ; Nagpal, Kamal ; Cosgrove, John Morgan</creator><creatorcontrib>Farkas, Daniel T. ; Moradi, Dovid ; Moaddel, David ; Nagpal, Kamal ; Cosgrove, John Morgan</creatorcontrib><description>Background
Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.
Methods
A retrospective chart review of 1,027 patients who underwent an attempted LC between January 2006 and December 2009 was performed. Patients were divided into five groups depending on their BMI: 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40. The primary endpoints were conversion rates, complication rates, and postoperative length of stay (LOS). Multivariate logistic regression was used to identify independent risk factors for worse outcomes.
Results
There were 211 (20.5%), 325 (31.6%), 268 (26.1%), 135 (13.1%), and 88 (8.6%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40, respectively. Seventy-three patients (7.1%) required conversion to open surgery, and 64 patients (6.2%) developed complications. The rate of conversion was similar amongst all the BMI groups (
P
= 0.366), as was the rate of complication (
P
= 0.483). Mean (±SD) postoperative LOS was 1.74 ± 3.87 days, and there was no difference between the BMI groups (
P
= 0.596). Male gender and emergent cholecystectomy were independent predictors of increased conversions and complications. Diabetes was a risk factor for conversion, whereas age >65 years was a risk factor for complications.
Conclusions
Increased BMI was not associated with worse outcomes after LC. Compared with normal weight patients, obese and even morbidly obese patients have no increased risk of conversion to open surgery, nor is there an increased risk of perioperative complications. Obese and morbidly obese patients who require a cholecystectomy should be considered in the same category as normal weight patients, and LC should be the standard of care.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-011-1978-5</identifier><identifier>PMID: 22011951</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Biological and medical sciences ; Body Mass Index ; Child ; Cholecystectomy ; Cholecystectomy, Laparoscopic - methods ; Cholecystectomy, Laparoscopic - statistics & numerical data ; Diabetes ; Female ; Gallbladder ; Gallstones ; Gallstones - complications ; Gallstones - surgery ; Gastroenterology ; General aspects ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Length of Stay ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Metabolic diseases ; Middle Aged ; Multivariate Analysis ; Obesity ; Overweight - complications ; Patients ; Postoperative Complications - etiology ; Proctology ; Regression analysis ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Treatment Outcome ; Young Adult</subject><ispartof>Surgical endoscopy, 2012-04, Vol.26 (4), p.964-969</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><rights>2015 INIST-CNRS</rights><rights>Springer Science+Business Media, LLC 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-46db361615889fd725508995d363ef0954419951d45e620c08df89b9acf724d13</citedby><cites>FETCH-LOGICAL-c499t-46db361615889fd725508995d363ef0954419951d45e620c08df89b9acf724d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-011-1978-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-011-1978-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25789649$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22011951$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farkas, Daniel T.</creatorcontrib><creatorcontrib>Moradi, Dovid</creatorcontrib><creatorcontrib>Moaddel, David</creatorcontrib><creatorcontrib>Nagpal, Kamal</creatorcontrib><creatorcontrib>Cosgrove, John Morgan</creatorcontrib><title>The impact of body mass index on outcomes after laparoscopic cholecystectomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.
Methods
A retrospective chart review of 1,027 patients who underwent an attempted LC between January 2006 and December 2009 was performed. Patients were divided into five groups depending on their BMI: 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40. The primary endpoints were conversion rates, complication rates, and postoperative length of stay (LOS). Multivariate logistic regression was used to identify independent risk factors for worse outcomes.
Results
There were 211 (20.5%), 325 (31.6%), 268 (26.1%), 135 (13.1%), and 88 (8.6%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40, respectively. Seventy-three patients (7.1%) required conversion to open surgery, and 64 patients (6.2%) developed complications. The rate of conversion was similar amongst all the BMI groups (
P
= 0.366), as was the rate of complication (
P
= 0.483). Mean (±SD) postoperative LOS was 1.74 ± 3.87 days, and there was no difference between the BMI groups (
P
= 0.596). Male gender and emergent cholecystectomy were independent predictors of increased conversions and complications. Diabetes was a risk factor for conversion, whereas age >65 years was a risk factor for complications.
Conclusions
Increased BMI was not associated with worse outcomes after LC. Compared with normal weight patients, obese and even morbidly obese patients have no increased risk of conversion to open surgery, nor is there an increased risk of perioperative complications. Obese and morbidly obese patients who require a cholecystectomy should be considered in the same category as normal weight patients, and LC should be the standard of care.</description><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Child</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy, Laparoscopic - methods</subject><subject>Cholecystectomy, Laparoscopic - statistics & numerical data</subject><subject>Diabetes</subject><subject>Female</subject><subject>Gallbladder</subject><subject>Gallstones</subject><subject>Gallstones - complications</subject><subject>Gallstones - surgery</subject><subject>Gastroenterology</subject><subject>General aspects</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Length of Stay</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic diseases</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Obesity</subject><subject>Overweight - complications</subject><subject>Patients</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Regression analysis</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUuLFDEUhYM4OG3rD3AjQRDd1JibR6XuUgYfAw2zGdchnYdTQ1WlTKrA_vem6dYBQVfhku-c-ziEvAJ2BYzpD4Ux2cqGATSAumvUE7IBKXjDOXRPyYahYA3XKC_J81IeWMUR1DNyyXnVoIIN2d3dB9qPs3ULTZHukz_Q0ZZC-8mHnzRNNK2LS2Mo1MYlZDrY2eZUXJp7R919GoI7lCW4JY2HF-Qi2qGEl-d3S759_nR3_bXZ3X65uf64a5xEXBrZ-r1ooQXVdRi95kqxDlF50YoQGSopoZbgpQotZ451Pna4R-ui5tKD2JJ3J985px9rKIsZ--LCMNgppLUYlNW4FSgq-f6_JHSohda8slvy5i_0Ia15qnsYFLIVUHtXCE6QqzcoOUQz5360-WCAmWMm5pSJqfc1x0yMqprXZ-N1Pwb_R_E7hAq8PQO2ODvEbCfXl0dO6bqNPE7IT1ypX9P3kB8n_Hf3X0buoYU</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Farkas, Daniel T.</creator><creator>Moradi, Dovid</creator><creator>Moaddel, David</creator><creator>Nagpal, Kamal</creator><creator>Cosgrove, John Morgan</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7TS</scope><scope>7X8</scope></search><sort><creationdate>20120401</creationdate><title>The impact of body mass index on outcomes after laparoscopic cholecystectomy</title><author>Farkas, Daniel T. ; Moradi, Dovid ; Moaddel, David ; Nagpal, Kamal ; Cosgrove, John Morgan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-46db361615889fd725508995d363ef0954419951d45e620c08df89b9acf724d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Child</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy, Laparoscopic - methods</topic><topic>Cholecystectomy, Laparoscopic - statistics & numerical data</topic><topic>Diabetes</topic><topic>Female</topic><topic>Gallbladder</topic><topic>Gallstones</topic><topic>Gallstones - complications</topic><topic>Gallstones - surgery</topic><topic>Gastroenterology</topic><topic>General aspects</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Length of Stay</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic diseases</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Obesity</topic><topic>Overweight - complications</topic><topic>Patients</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Regression analysis</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farkas, Daniel T.</creatorcontrib><creatorcontrib>Moradi, Dovid</creatorcontrib><creatorcontrib>Moaddel, David</creatorcontrib><creatorcontrib>Nagpal, Kamal</creatorcontrib><creatorcontrib>Cosgrove, John Morgan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Physical Education Index</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farkas, Daniel T.</au><au>Moradi, Dovid</au><au>Moaddel, David</au><au>Nagpal, Kamal</au><au>Cosgrove, John Morgan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of body mass index on outcomes after laparoscopic cholecystectomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>26</volume><issue>4</issue><spage>964</spage><epage>969</epage><pages>964-969</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Background
Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.
Methods
A retrospective chart review of 1,027 patients who underwent an attempted LC between January 2006 and December 2009 was performed. Patients were divided into five groups depending on their BMI: 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40. The primary endpoints were conversion rates, complication rates, and postoperative length of stay (LOS). Multivariate logistic regression was used to identify independent risk factors for worse outcomes.
Results
There were 211 (20.5%), 325 (31.6%), 268 (26.1%), 135 (13.1%), and 88 (8.6%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40, respectively. Seventy-three patients (7.1%) required conversion to open surgery, and 64 patients (6.2%) developed complications. The rate of conversion was similar amongst all the BMI groups (
P
= 0.366), as was the rate of complication (
P
= 0.483). Mean (±SD) postoperative LOS was 1.74 ± 3.87 days, and there was no difference between the BMI groups (
P
= 0.596). Male gender and emergent cholecystectomy were independent predictors of increased conversions and complications. Diabetes was a risk factor for conversion, whereas age >65 years was a risk factor for complications.
Conclusions
Increased BMI was not associated with worse outcomes after LC. Compared with normal weight patients, obese and even morbidly obese patients have no increased risk of conversion to open surgery, nor is there an increased risk of perioperative complications. Obese and morbidly obese patients who require a cholecystectomy should be considered in the same category as normal weight patients, and LC should be the standard of care.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22011951</pmid><doi>10.1007/s00464-011-1978-5</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdominal Surgery Adolescent Adult Aged Aged, 80 and over Analysis of Variance Biological and medical sciences Body Mass Index Child Cholecystectomy Cholecystectomy, Laparoscopic - methods Cholecystectomy, Laparoscopic - statistics & numerical data Diabetes Female Gallbladder Gallstones Gallstones - complications Gallstones - surgery Gastroenterology General aspects Gynecology Hepatology Humans Laparoscopy Length of Stay Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Medicine Medicine & Public Health Metabolic diseases Middle Aged Multivariate Analysis Obesity Overweight - complications Patients Postoperative Complications - etiology Proctology Regression analysis Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Treatment Outcome Young Adult |
| title | The impact of body mass index on outcomes after laparoscopic cholecystectomy |
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