title: Obesity does not increase complications following pancreatic surgery.
abstract: BACKGROUND
  Recent evidence suggests that the quantity of intra-abdominal fat may be a more important predictor of postoperative complications than body mass index (BMI). We hypothesized that increased intra-abdominal fat would be associated with longer operations, increased blood loss, more complications, and prolonged length of stay after pancreatic resection.
  
  
  METHODS
  Retrospective cohort study. Intra-abdominal fat was quantified using CT imaging, and patients were divided into three groups (low, moderate, high). Unconditional multiple logistic regression was used to evaluate the relationship between obesity measures and complications.
  
  
  RESULTS
  Between 2002 and 2010, 255 patients underwent pancreaticoduodenectomy or distal pancreatectomy, and 201 had preoperative CT imaging available for review. Operative time was significantly prolonged in patients with high quantities of intra-abdominal fat compared with those with low fat quantity (median 438 versus 354 min, P < 0.05), while BMI was not associated with changes in duration of surgery. Neither obesity defined by BMI (OR 0.90, 95% CI 0.36-2.21) nor visceral fat (OR 1.20, 95% CI 0.46-3.16) significantly predicted risk of complications. Median length of stay was similar in patients who were obese by BMI (7 versus 7.5 d) or amount of intra-abdominal fat (7 d).
  
  
  CONCLUSIONS
  Intra-abdominal fat was a better predictor than BMI for determining length of procedure. However, in contrast to previous studies evaluating abdominal surgery, neither BMI nor intra-abdominal fat significantly predicted risk of complication or length of hospital stay. Further research is needed to determine the best measure to assist in risk prediction of obese patients undergoing pancreatic surgery.
authors.affiliation: Houston VA HSR&D Center of Excellence, Houston, Texas, USA. cb131098@bcm.tmc.edu
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Jose
authors.initials: J
authors.lastname: Enriquez
authors.forename: Guillermina
authors.initials: G
authors.lastname: Cruz
authors.forename: Sally
authors.initials: S
authors.lastname: Hodges
authors.forename: Vivek
authors.initials: V
authors.lastname: Bansal
authors.forename: Eunji
authors.initials: E
authors.lastname: Jo
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ahern
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: Nancy
authors.initials: N
authors.lastname: Petersen
authors.forename: Eric
authors.initials: E
authors.lastname: Silberfein
authors.forename: F Charles
authors.initials: FC
authors.lastname: Brunicardi
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: William
authors.initials: W
authors.lastname: Fisher
mesh_terms: D050153:Abdominal Fat; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D010182:Pancreatic Diseases / Q000453:epidemiology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors