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  • Author
    Sarah Rudasill
  • Co-author

    Joseph Hadaya MD, Yas Sanaiha MD, Zachary Tran MD, Peyman Benharash MD

  • Title

    The Obesity Paradox: Underweight Patients are at Greatest Risk of Mortality Following Cholecystectomy

  • Abstract

    Elevated body mass index (BMI) is a risk factor for gallstone disease and cholecystectomy, but outcomes for low BMI patients remain uncharacterized. We examined the association of BMI with morbidity, mortality, and resource use following cholecystectomy.

    The 2005-2016 American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed for adult patients undergoing laparoscopic and open cholecystectomy. Patients were stratified into five groups: BMI<18.5 (Underweight), BMI 18.5-24.9 (Normal Weight), BMI 25-29.9 (Overweight), BMI 30-34.9 (Class I Obesity), BMI 35-39.9 (Class II Obesity), and BMI ≥40 (Class III Obesity). Multivariable regressions identified independent associations of covariates with 30-day mortality, complications, and resource use.

    Of 327,473 cholecystectomy patients, 1.0% were Underweight, 19.5% Normal Weight, 30.3% Overweight, 24.0% Class I Obesity, 13.5% Class II Obesity, and 11.7% Class III Obesity. After multivariable analysis, Underweight patients had higher risk of mortality (adjusted odds ratio (AOR)=1.53, p=0.029) and postoperative bleeding (AOR=1.45, p=0.011) relative to Normal Weight patients. Conversely, Class III Obesity patients had lower mortality (AOR=0.66, p=0.005) but increased operative time (β=10.2 minutes, p<0.001), wound infection (AOR=1.38, p<0.001), and wound dehiscence (AOR=2.20; p<0.001). Hospital length of stay and readmission rates were highest for Underweight patients.

    Underweight patients experience increased risk of mortality and readmission while Class III Obesity patients have higher rates of wound infection and dehiscence as well as prolonged operative time. These findings may guide choice of intervention.

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