دورية أكاديمية
Impact of Morbid Obesity on Post-esophagectomy Leak Rate: a NSQIP Analysis.
| العنوان: | Impact of Morbid Obesity on Post-esophagectomy Leak Rate: a NSQIP Analysis. |
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| المؤلفون: | Conroy MA; Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA., O'Connor AL; Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA., Qureshi AP; Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA., Wood SG; Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA. woodste@ohsu.edu. |
| المصدر: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Aug; Vol. 27 (8), pp. 1539-1544. Date of Electronic Publication: 2023 Apr 20. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier B.V Country of Publication: United States NLM ID: 9706084 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4626 (Electronic) Linking ISSN: 1091255X NLM ISO Abbreviation: J Gastrointest Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2024-: [Amsterdam] : Elsevier B.V. Original Publication: St. Louis, MO : Quality Medical Pub., c1997- |
| مواضيع طبية MeSH: | Obesity, Morbid*/complications , Obesity, Morbid*/surgery , Esophageal Neoplasms*/pathology , Hypertension*/complications, Humans ; Female ; Middle Aged ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Quality Improvement ; Retrospective Studies ; Treatment Outcome ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery |
| مستخلص: | Background: Morbid obesity is becoming more prevalent and is a known risk factor for esophageal cancer. Esophagectomy in this population is technically more challenging than the non-obese, thus increasing the risks of surgery. This study hypothesizes that higher body mass index (BMI) is associated with higher anastomotic leak rates after esophagectomy. Methods: This study is a retrospective review of patients undergoing esophagectomy in the National Surgical Quality Improvement Program (NSQIP) Targeted Esophagectomy database from 2016 to 2019. Patients were stratified by BMI < 35 versus BMI > 35, with the primary outcome being leak post-esophagectomy. Univariate analyses were performed for demographics and post-operative outcomes, and multivariate analyses were performed specifically for the primary outcome of anastomotic leak (all diagnoses and malignancy/dysplasia subgroup). This study was approved by the Institutional Review Board. Results: Of 4165 patients, 439 (10.5%) had a BMI > 35. Patients with BMI > 35 were often younger (mean age 60 vs 64 years, p < 0.001), White (p < 0.001), female (p < 0.001), non-smoker (p < 0.001), diabetic (p < 0.001), with hypertension (p < 0.001), and ASA ≥ 3 (p < 0.001). There were no differences between BMI groups with regard to indication for esophagectomy (malignancy/dysphasia vs other), conversion to open, mortality, or length of stay. The BMI > 35 cohort reported higher operative times (p < 0.001), open operative approach (p = 0.04), superficial surgical site infection (p < 0.001), return to operating room (p = 0.01), and leak (13.5% vs 10.1%, p = 0.01). BMI > 35 was not an independent predictor of leak for all diagnoses; however, the subgroup analysis of esophagectomy for malignancy/dysplasia demonstrated that BMI > 35 was predictive of leak (OR 1.42, 95% CI 1.05-1.91), as well as operative time and hypertension. Conclusion: Patients with a BMI > 35 and who undergo esophagectomy have a higher rate of anastomotic leak. BMI > 35 was also an independent predictor of leak when esophagectomy was performed for malignancy/dysplasia, but not for all diagnoses. The risk of anastomotic leak should be considered in morbidly obese patients undergoing esophagectomy, particularly for malignancy. (© 2023. The Society for Surgery of the Alimentary Tract.) |
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| فهرسة مساهمة: | Keywords: Anastomotic leak; Esophageal cancer; Esophagectomy; Minimally invasive esophagectomy; Morbid obesity |
| تواريخ الأحداث: | Date Created: 20230420 Date Completed: 20230811 Latest Revision: 20240213 |
| رمز التحديث: | 20240213 |
| DOI: | 10.1007/s11605-023-05669-x |
| PMID: | 37081219 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1873-4626 |
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| DOI: | 10.1007/s11605-023-05669-x |