title: Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates.
abstract: BACKGROUND
  Preoperative body mass index (pre-BMI) affecting patients' recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites.
  
  
  METHODS
  Postoperative BMI values and ascites volumes of 206 patients undergoing OLT (2006-2007) were reviewed.
  
  
  RESULTS
  There were 141 preoperatively "non-obese" patients (pre-BMI ≤ 30 kg/m2) and 65 "obese" patients (pre-BMI >30 kg/m2). Demographics and model for end-stage liver disease scores were similar for both groups. The mean volume of ascites removed from the "non-obese" patients was significantly larger compared to the "obese" ones (P=0.018). Seventeen "obese" patients became "non-obese" postoperatively. The duration of anesthesia, ischemia, surgery, hemodynamic parameters, estimated blood loss and transfused products were similar for both groups. Ascites volumes correlated significantly (P<0.05) with various intraoperative indices but not pre-BMI. At 24 h postoperatively, the extubation rate was better for the "obese" group (99%) versus the "non-obese" group (93%, P=0.03). However, "non-obese" patients were extubated earlier than the "obese" both by 6 h (45% versus 22%, respectively, P<0.01) and by 12 h (88% versus 74%, respectively, P=0.012). The postoperative, but not the preoperative BMI, correlated with extubation rate ≤ 6 h (r=0.924, P=0.0001). No "obese" patients died <1 month postoperatively, compared to 9 "non-obese" patients (P<0.01). Intensive Care Unit and hospital stay were ~25% longer for the "obese" group.
  
  
  CONCLUSIONS
  Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Vater
authors.forename: G
authors.initials: G
authors.lastname: Dembo
authors.forename: K
authors.initials: K
authors.lastname: Martay
authors.forename: A
authors.initials: A
authors.lastname: Vitin
authors.forename: E
authors.initials: E
authors.lastname: Amar
authors.forename: A A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000368:Aged; D060666:Airway Extubation; D000758:Anesthesia; D001201:Ascites / Q000473:pathology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D003422:Critical Care; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D059035:Perioperative Period; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D010100:Oxygen