title: Obesity does not increase morbidity of laparoscopic cholecystectomy.
abstract: BACKGROUND
  Obesity has historically been a positive predictor of surgical morbidity, especially in the morbidly obese. The purpose of our study was to compare outcomes of obese patients undergoing laparoscopic cholecystectomy (LC).
  
  
  METHODS
  We reviewed 1382 consecutive patients retrospectively who underwent LC for various pathologies from January 2008 to August 2011. Patients were stratified based on the World Health Organization definitions of obesity: nonobese (body mass index [BMI] < 30 kg/m(2)), obesity class I (BMI 30-34.9 kg/m(2)), obesity class II (BMI 35-39.9 kg/m(2)), and obesity class III (BMI ≥ 40 kg/m(2)). The primary end points were conversion rates and surgical morbidity. The secondary end point was length of stay.
  
  
  RESULTS
  There were significantly more females in the obesity II and III groups (P = 0.0002). American Society of Anesthesiologists scores were significantly higher in the obesity I, II, and III groups compared with the nonobese (P < 0.05; P < 0.01; and P < 0.0001, respectively). Independent predictors of conversion on multivariate analysis (MVA) included age (P = 0.01), acute cholecystitis (P = 0.03), operative time (P < 0.0001), blood loss (P < 0.0001), and fellowship-trained surgeons (P < 0.0001). Independent predictors of intraoperative complications on MVA included age (P = 0.009), white patients (P = 0.009), previous surgery (P = 0.001), operative time (P < 0.0001), and blood loss (P = 0.01). Independent predictors of postoperative complications on MVA included American Society of Anesthesiologists score (P < 0.0001), acute cholecystitis (P < 0.0001), and a postoperative complication (P < 0.0001). BMI was not a predictor of conversions or surgical morbidity. Length of stay was not significantly different between the four groups.
  
  
  CONCLUSIONS
  This study demonstrates that overall conversion rates and surgical morbidity are relatively low following LC, even in obese and morbidly obese patients.
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. Electronic address: cafaneh@gmail.com.
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Abelson
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Barrie S
authors.initials: BS
authors.lastname: Rich
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dakin
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York; Department of Public Health, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Complication; Conversion; Laparoscopic cholecystectomy; Morbid obesity; Morbidity; Obesity; Outcomes