Factors influencing infectious complications after pancreatoduodenectomy

Abstract

This study demonstrates the need for careful postoperative monitoring in the patient with high BMI.

Body Mass Index and Outcomes from Pancreatic Resection: a Review and Meta-analysis

“…For descriptive BMI-associated outcome analyses, we separated patients into BMI-unit intervals for normal weight (BMI [18][19][20][21][22][23][24][25], overweight (25)(26)(27)(28)(29)(30), and obese (>30) patients. Because BMI was reported inconsistently across the primary study cohort, our analyses frequently evaluated BMI <25 versus >25, and BMI >30 versus <30, though we compared all three tiers whenever possible.…”

“…Four studies split BMI into three tiers and yielded 881 patients with a stratified BMI <25, 592 patients with a BMI >30 and 546 patients with a BMI between 25 and 30. 16,21,22,24 Eleven other studies assessed BMI only as >30 versus <30 or >25 versus <25, and these studies provided 1,309 patients with BMI <30 and 328 patients with BMI >25. 14,15,17,23,[83][84][85][86][87][88][89][90][91] One study assessed outcomes for patients with BMI >27 versus <27, and 216 patients therein with BMI >27 were included in our >25 comparator group, though we could not include the remaining 213 patients with BMI <27 from the primary study in any of our analyses.…”

“…This diversity of indication and intervention was present within many individual studies. 16,20,22,23,64,68,73,75,77,79,80,82,83,[85][86][87][88][89][90] Consequently, we could not stratify outcomes by these conditions, though more research is necessary to illuminate the possibility of 24,85 Of five studies utilizing the ISGPF definition of PF, 23,83,85,86,89 three found a multivariate association between PF and BMI, one found no association, and one did not include a multivariate analysis. Two studies found an association between clinically relevant PF and BMI >27 (OR 3.4) and >30 (OR 6.5).…”

“…81,82 In all, 17 studies were included in the final set (Table 1). [14][15][16][17][21][22][23][24][83][84][85][86][87][88][89][90][91] All primary studies reported retrospective analyses of prospectively maintained databases, suggesting that selection bias may exist in this body of literature. Our 17 study cohort included a total of 4,045 patients, though BMI information was reported heterogeneously.…”

“…13 In both cases, surgical pancreatic resection is imperative. However, obesity has also been linked to a variety of peri-and post-surgical complications following pancreatectomy, including increased length of hospital stay (LOS), [14][15][16][17] surgical site infection, [18][19][20] blood loss, 21,22 and decreased disease-free and overall survival. 15 Conversely, though increased BMI is frequently cited as a risk factor for deleterious peri-surgical outcomes in patients undergoing pancreatic resection, its application as a universal predictor seems to be unfounded.…”