The impact of obesity and severe obesity on postoperative outcomes after pancreatoduodenectomy

Background The impact of obesity on postoperative outcomes after pancreatoduodenectomy remains insufficiently studied. Methods All pancreatoduodenectomy patients were abstracted from the 2014 to 2018 American College of Surgeons National Surgical Quality Improvement Program data sets and were stratified into the following 3 body mass index categories: non-obese (body mass index 18.5–29.9), class 1/2 obesity (body mass index 30–39.9), and class 3 severe obesity (body mass index ≥ 40). Analyses tested associations between patient factors and four 30-day postoperative outcomes: mortality, composite morbidity, delayed gastric emptying, and postoperative pancreatic fistula. Multivariable logistic regression models tested independent associations between patient factors and these 4 outcome measures. Results A total of 16,823 patients were included in the study: 12,234 (72.7%) non-obese, 4,030 (24%) obese, and 559 (3.3%) with severe obesity. Bivariable analyses demonstrated significant associations between obesity, severe obesity, and greater proportions of numerous preoperative comorbidities as well as a greater likelihood of postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, composite morbidity, and mortality (all P ≤ .001). After adjusting for significant covariates, obesity was independently associated with postoperative pancreatic fistula (odds ratio 1.49, 95% confidence interval: 1.33–1.67, P < .001), delayed gastric emptying (odds ratio 1.16, 95% confidence interval: 1.05–1.28, P = .004), composite morbidity (odds ratio 1.28, 95% confidence interval: 1.18–1.38, P < .001), and mortality (odds ratio 1.79, 95% confidence interval: 1.36–2.36, P < .001). Conclusion Obesity and severe obesity are significantly associated with worse short-term outcomes after pancreatoduodenectomy. Preoperative considerations, such as weight management strategies during individualized treatment planning, could improve outcomes in this population.