Clinical

Higher liver surgery mortality for extremely obese patients

Last Updated: 2011-12-22 14:11:10 -0400 (Reuters Health)

By Anne Harding

NEW YORK (Reuters Health) - Extremely obese patients have higher 30-day mortality after liver resection, according to a new analysis of data from Veterans Affairs medical centers.

The investigation, in 403 patients, did not find increased mortality or morbidity for overweight or less-obese patients, researchers said in a December 19 online report in Archives of Surgery.

Operating on heavier patients is more difficult, but there is little clear data on whether or not their outcomes are actually worse, Dr. Marcovalerio Melis, the paper's senior author, told Reuters Health.

"This is the common perception when we are in the operating room, but there are very little statistics that support this impression," he added. "Most of the information on outcomes relative to BMI available in the literature is somewhat discordant."

To investigate, Dr. Melis, of the New York Harbor Healthcare System Veterans Affairs Medical Center in Manhattan, and his team looked at data from the VA's Surgical Quality Improvement Program database on 403 patients who had liver resection, including 106 of normal weight, 161 who were overweight (BMI 25.0-29.9), 94 who were obese class 1 (BMI 30.0-34.9), 31 in obese class 2 (BMI 35.0-39.9), and 11 in obese class 3 (BMI 40.0 and above).

There were no differences among the BMI groups in overall or specific morbidity or length of stay. Obese class 3 patients did receive more blood transfusions (4.3, on average, compared to 1.1 for normal weight patients, P=0.02), and 27% died within 30 days of surgery, compared to 6% of normal-weight patients (P=0.05).

On multivariate analysis, a BMI of 40 or higher was independently linked to an increased risk of death.

"What this study is telling us is that if you have severe obesity and you are exposed to a complication, your chances of getting out of that complication are lower than the chances you would have if you were normal weight or at least a lower degree of obesity," Dr. Melis said.

However, he added, there were limitations to the study, including the lack of information on surgery-specific complications or patients' degree of hepatic steatosis.

Dr. J. Michael Millis of the University of Chicago, who wrote an invited critique published with the study, told Reuters Health the report "provides some analysis, but it doesn't really answer the question of how we as surgeons can better manage the obese patient with liver problems."

"You'd have to have more patients and you'd have to have more details really focused on the problems that liver patients have," he said.

All surgeons will agree that morbidly obese patients pose a greater challenge to operate on, Dr. Millis added. "Whether that in fact translates into worse outcomes, the data is really just not there."

SOURCE: http://bit.ly/uzTuzX

Arch Surg 2011.