An Age-BMI Compound Variable Predicts Morbidity and Mortality Following Pancreaticoduodenectomy: An NSQIP Analysis

Abstract

Introduction: Pancreaticoduodenectomy (PD) is the recommended surgical therapy for periampullary lesions including pancreatic head tumors or select iatrogenic and inflammatory conditions. We sought to explore the impact of age and BMI in determining outcomes of PD. Methods: The ACS-NSQIP pancreatectomy targeted file was used to identify PDs from 2014-2019. Patients were stratified into eight different categories according to a compound age-BMI variable and risk-adjusted. Age of 65 years was set for young vs elderly. Obesity was classified as class I (BMI 30-35), class II (BMI 35-40), and class III (BMI >40). Young-normal/overweight-(BMI<30) was considered as the reference group. Results: Young-obese class I (OR 1.23, p = 0.003), young-obese class III (OR 1.54, p = 0.03), and elderly-obese class II (OR 1.51, p-value = 0.003) had statistically significant higher odds of morbidity/mortality. Young-obese class I (OR 1.95, p <0.001), young-obese class II (OR 1.59, p = 0.018), young-obese class III (OR 3.24, p <0.001), elderly-obese class I (OR 1.38, p = 0.008), elderly-obese class II (OR 1.76, p = 0.001), and elderly-obese class III (OR 1.65, p = 0.005) had statistically significant higher odds of postoperative pancreatic fistula formation. Young-obese class I (OR 1.66, p = 0.002), elderly-obese class II (OR 1.96, p = 0.001), and elderly-obese class III (OR 2.19, p = 0.007) had statistically significant higher odds of drain remaining at POD30. Conclusions: The combination of age <65 years and BMI >40 kg/m2 composite variable constitutes a significantly increased risk of postoperative morbidity/mortality and POPF formation post PD.