Preoperative Body Mass Index in Predicting Postoperative Outcomes in Patients after Pancreaticoduodenectomy

Abstract

Introduction: Morbidity remains a common problem following pancreaticoduodenectomy. Whether preoperative body weight is associated with short-term outcomes in patients after pancreaticoduodenectomy is controversial. This study aims to investigate the relationship between preoperative body mass index and postoperative short-term outcomes in patients after pancreaticoduodenectomy. Method: The patients undergoing pancreaticoduodenectomy from January 2016 to December 2020 in our center were consecutively enrolled in this study. These patients were divided into 3 groups according to the preoperative body mass index (BMI): low-BMI group (BMI ≤ 18.4 kg/m2), normal- BMI group (BMI 18.5∼24.9 kg/m2) and high-BMI group (BMI ≥ 25.0 kg/m2). Univariable and multivariable logistic regression analyses were performed to identify the risk factors of postoperative morbidity after pancreaticoduodenectomy. Results: Of 475 patients, 41(8.6%), 288 (60.6%), and 146 (30.7%) were low-BMI, normal-BMI, and high-BMI, respectively. Postoperative overall mortality and morbidity were 1.7% and 49.5% in the whole cohort. There were no differences in 30-day mortality among the three groups. Compared with normal- BMI group, 30-day morbidity were significantly higher in low-BMI group (63.4% vs. 44.1%, P = 0.020) and high-BMI group (55.5% vs. 44.1%, P = 0.025). Multivariable analyses identified both low-BMI and high-BMI were independent associated with overall morbidity (OR 1.790, 95% CI 1.158-2.912, P = 0.005, and OR 1.635, 95% CI 1.094-2.785, P = 0.015). The similar results were also confirmed for the incidence of postoperative 30-day pancreatic fistula and surgical site infection. Conclusions: BMI could be used to predict postoperative morbidity and mortality for patients treated with pancreaticoduodenectomy.