title: Obesity and its implications for morbidity and mortality after cholecystectomy: A matched NSQIP analysis.
abstract: BACKGROUND
  The risks from super obesity (SO) following cholecystectomy have not been studied.
  
  
  METHODS
  NSQIP analysis of patients undergoing cholecystectomy from 2005 to 2011. Non-obese (NO) patients (BMI 18.5-30) were matched 1:1 by age, sex, race and comorbidities to morbidly obese (MO) (BMI 35-50), and separately to SO (BMI≥50) individuals. Clavien 4 complications and 30-day mortality were compared.
  
  
  RESULTS
  13780 MO and 1410 SO patients were matched to NO patients. Obese patients were more likely to present with chronic (CC) rather than acute cholecystitis (AC). Compared to NO patients, Clavien 4 complications were significantly increased among SO patients overall especially with AC where rate of open surgery was significantly higher.
  
  
  CONCLUSIONS
  SO patients have an increased risk of serious morbidity after cholecystectomy especially with AC where rate of open surgery remains high. Aggressive recommendation for cholecystectomy to reduce presentation with AC and increase likelihood for laparoscopic surgery may be beneficial in SO patients.
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: augustt@ccf.org.
authors.forename: Toms
authors.initials: T
authors.lastname: Augustin
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: moslimm@ccf.org.
authors.forename: Maitham A
authors.initials: MA
authors.lastname: Moslim
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: brethas@ccf.org.
authors.forename: Stacy
authors.initials: S
authors.lastname: Brethauer
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: aminiaa@ccf.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: krohm@ccf.org.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, 75 Francis St, Boston, MA, USA. Electronic address: eschnei1@jhmi.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Schneider
authors.affiliation: Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: walshm@ccf.org.
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D002764:Cholecystitis / Q000601:surgery*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014481:United States
keywords: Cholecystectomy; Laparoscopy; Morbid-obesity; Mortality; NSQIP; Serious complications; Super-obesity