Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy

James Jeffery Reeves; Brittany N Burton; Ryan C Broderick; Ruth S Waterman; Rodney A Gabriel

doi:10.1007/s00464-020-07514-7

Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy

Surg Endosc. 2021 Mar;35(3):1348-1354. doi: 10.1007/s00464-020-07514-7. Epub 2020 Mar 23.

Authors

James Jeffery Reeves¹, Brittany N Burton², Ryan C Broderick³, Ruth S Waterman⁴, Rodney A Gabriel^{4

5}

Affiliations

¹ Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, MC7400, La Jolla, CA, 92037-7400, USA. jreeves@health.ucsd.edu.
² Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza suite 3325, Los Angeles, CA, 90095, USA.
³ Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, MC7400, La Jolla, CA, 92037-7400, USA.
⁴ Department of Anesthesiology, University of California, San Diego, 9300 Campus Point Drive MC7770, La Jolla, CA, 92031-7770, USA.
⁵ Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.

PMID: 32206919
DOI: 10.1007/s00464-020-07514-7

Abstract

Introduction: Compared to other common outpatient operations, laparoscopic cholecystectomy has higher rates of unanticipated hospital admission with reports ranging from 1.0 to 39.5%. Identification of simple preoperative risk factors for admission can aid appropriate patient selection. The aim of this study was to evaluate the association of obesity with need for hospital admission and day of surgery postoperative complications.

Methods: The ACS NSQIP database from 2007 to 2016 was used to evaluate patients ≥ 18 years old who had undergone outpatient laparoscopic cholecystectomy. The primary outcome was hospital admission, defined as hospital length of stay ≥ 24 h. The secondary endpoint was postoperative complications on day of surgery. A multivariable logistic regression was used to evaluate the association of body mass index (BMI) and the outcomes of interest. Odds ratio (OR) and their 95% confidence interval (CI) were reported.

Results: 192,750 patients underwent laparoscopic cholecystectomy in the outpatient setting. 38,945 (20.20%) required hospital admission. 89 (0.05%) had postoperative complications on the day of surgery. On multivariable logistic regression analysis, when compared to the baseline cohort of BMI ≥ 30 and < 40 kg/m², patients with a BMI ≥ 50 kg/m² had a 10% increased odds of hospital admission (OR 1.10, CI 1.02-1.19, p < 0.001). BMI ≥ 40 kg/m² and < 50 kg/m² was not associated with increased odds of hospital admission (OR 0.99, CI 0.95-1.03, p 0.725). There was no increased odds of postoperative complications for patients with higher BMI (OR 1.35, CI 0.32-3.89, p < 0.623).

Conclusion: Patients with super obesity have a 10% increased odds of hospital admission following laparoscopic cholecystectomy. Obesity is not associated with increased odds of same-day postoperative complications. Ambulatory laparoscopic cholecystectomy for the morbidly obese is safe; however, those with BMI > 50 kg/m² should be considered on a case-by-case basis.

Keywords: Ambulatory surgery; Laparoscopic cholecystectomy; Risk factors for unanticipated admission; Same-day postoperative complications; Unanticipated admission.

MeSH terms

Adult
Cholecystectomy, Laparoscopic / adverse effects*
Female
Hospitalization
Humans
Male
Middle Aged
Obesity, Morbid / complications*
Outpatients
Retrospective Studies
Risk Factors