title: Extremes of body mass index and postoperative complications after esophagectomy.
abstract: Obesity has been variously associated with reduced or similar rates of postoperative complications compared to normal weight patients undergoing esophagectomy for cancer. In contrast, little is known about esophagectomy risks in the underweight population. The relationship between the extremes of body mass index (BMI) and postoperative complications after esophagectomy was evaluated. Consecutive esophagectomy patients (2000-2013) were reviewed. The patients were stratified based on BMI at the time of diagnosis: underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese I (30-34.9), and obese II or III (≥35). Hospital length of stay as well as postoperative complications and their accordion severity grading were evaluated according to the BMI category. Of 388 patients, 78.6% were male with a median age of 62 years at the time of operation. Pathologic cancer stage was 0 to I in 53%. BMI distribution was as follows: 5.6% underweight, 28.7% normal, 31.4% overweight, 22.8% obese I, and 11.5% obese II or III. Performance status was 0 or 1 in 99.2%. Compared to normal BMI patients, underweight patients had increased pulmonary complications (odds ratio (OR) 3.32, P = 0.014) and increased other postoperative complications (OR 3.00, P = 0.043). Patients who were overweight did not have increased complications compared to normal BMI patients. BMI groups did not differ in mortality rates or complication accordion severity grading. Hospital length of stay trended toward a longer duration in the underweight population (P = 0.06). Underweight patients are at increased risk for postoperative pulmonary and other complications. Underweight patients may benefit from preoperative nutritional repletion and mitigation for sarcopenia. Aggressive postoperative pulmonary care may help reduce complications in these patients. In contrast, the operative risk in overweight and obese patients is similar to normal BMI patients.
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Wightman
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.|Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Posner
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
authors.affiliation: Department of Surgery, Southern Illinois University, Springfield, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ganai
authors.affiliation: ?Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Watson
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: V
authors.initials: V
authors.lastname: Prachand
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.|Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Ferguson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D050177:Overweight / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013851:Thinness / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: body mass index; complications; esophageal cancer surgery; esophageal carcinoma; nutrition