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Morbid Obesity Does Not Adversely Affect Mortality or Length of Hospital Stay After Liver Resection - 14 Year Retrospective Analysis
Raghavendra Rao*, Kenneth W. Bueltmann, Marek Rudnicki
Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL
Introduction: Obesity is an important co-morbidity present in modern day surgical patients. In addition to affecting wound healing, obesity can present technical difficulties and has an apparent effect upon outcomes due to concomitant liver disease in patients undergoing liver resections. This study was undertaken to test whether morbid obesity affects early outcomes of selected major liver surgeries and if that effect has changed over the observed time period.
Methods: The National Inpatient Sample database was queried for all records who had their primary or secondary procedure recorded as hepatic lobectomy (ICD 50.22) or partial hepatectomy (ICD 50.3) or both. The records were then classified into patients with or without morbid obesity (ICD 278.01). Means were calculated for every year from 1998 to 2011 for mortality rate and length of hospital stay. Chi square test was used to test for significance in difference in mortality and Weighted T-test was used to test for significance in difference in lengths of stay.
Results: The number of partial hepatectomy or hepatic lobectomy procedures recorded increased 1426 to 3206 (2.25 fold) from 1998 to 2011 (1426 to 3206, 2.25 fold).
This increase was more prominent in the morbidly obese population (13 to 319, 24.5 fold). Non obese patients who underwent surgery during the first half of the decade, 1998 to 2004 had higher mortality compared to those in the second half, 2005 to 2011 (4.23%, 312/7384 vs 2.84%, 339/11941 and 6.69%, 262/3915 vs 4.91%, 243/3949) for hepatic lobectomy and partial hepatectomy respectively (p<0.001 for both). This difference was not significant in the morbidly obese population. Partial hepatectomy in the obese population demonstrated reduced mortality in the first half of the decade (6.69 vs 0%) only, while "hepatic lobectomy" had reduced mortality in morbidly obese in the second half of decade (2.84% vs 0.77%), but only compared to the non-obese population. Morbidly obese patients had reduced mortality and length of stay for hepatic lobectomy (0.96%, 11/1144 vs 3.37%, 651/19325, p<0.001 and 7.31 vs 9.32 days, p<0.001) and partial hepatectomy (2.4%, 9/370 vs 5.7%, 505/8864, p<0.001 and 8.5 vs 9.9 days, p<0.01).
Conclusion: Morbid obesity did not increase mortality and length of stay after liver resection surgery. Surprisingly, both mortality and length of stay were lower in obese patients undergoing major liver surgeries. While mortality has improved with time in the non-obese population after liver resection, this has not been the case with the morbidly obese population.
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