Advertisement

Journal of Anesthesia

, Volume 32, Issue 4, pp 624–631 | Cite as

The impact of low body mass index on postoperative outcomes in pancreatectomy patients: a retrospective analysis of Japanese administrative data

  • Takeshi Umegaki
  • Susumu Kunisawa
  • Masaya Kotsuka
  • So Yamaki
  • Takahiko Kamibayashi
  • Yuichi Imanaka
Original Article
  • 132 Downloads

Abstract

Purpose

To comparatively examine in-hospital mortality among different underweight body mass index (BMI) categories in pancreatic cancer patients after pancreatectomy in Japan.

Methods

We conducted a large-scale multi-center retrospective cohort study of adult patients with pancreatic cancer who underwent pancreatectomy between April 1, 2010 and March 31, 2016. Patients were classified according to BMI as follows: normal BMI (18.50–24.99 kg/m2), mild thinness (17.00–18.49 kg/m2), moderate thinness (16.00–16.99 kg/m2), and severe thinness (< 16.00 kg/m2). A multivariable logistic regression analysis was performed with in-hospital mortality as the dependent variable and BMI groups as the main independent variable of interest.

Results

We analyzed 6173 patients from 332 hospitals. The results showed that the severe thinness group had a longer postoperative hospital stay (34.4 ± 25.6 days) and higher incidence of postoperative pneumonia (5.5%) than the other groups. The generalized estimating equations accounted for patient demographics, surgical procedure, anesthetic technique, activities of daily living score, and Charlson comorbidity index as covariates. Relative to the normal BMI group, the odds ratios for in-hospital mortality were 0.57 (95% confidence interval: 0.26–1.24; P = 0.16) in the mild thinness group, 1.49 (0.64–3.48; P = 0.36) in the moderate thinness group, and 2.54 (1.05–6.08; P = 0.04) in the severe thinness group.

Conclusion

Severe thinness was significantly associated with a higher risk of mortality, and extremely low BMI should be considered a risk factor in pancreatectomy patients.

Keywords

Body mass index Underweight Pancreatic cancer Pancreatectomy In-hospital mortality 

Notes

Acknowledgements

This study was supported in part by a Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan (H29-seisaku-sitei-009), a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant number: [A] 16H02634), and the Mitsui Life Social Welfare Foundation. The funders were not involved in study design, data collection, data analysis, manuscript preparation, or the decision to publish. The authors had complete access to the study data.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest, financial or otherwise.

References

  1. 1.
    Vital statistics of Japan. 2016. Ministry of Health, Labour and Welfare.Google Scholar
  2. 2.
    Summary of Static/Dynamic Survey of Medical Institutions and. Report H. 2014. Ministry of Health, Labour and Welfare.Google Scholar
  3. 3.
    Summary of Static/Dynamic Survey of Medical Institutions and. Report H. 2008. Ministry of Health, Labour and Welfare.Google Scholar
  4. 4.
    Summary of Static/Dynamic Survey of Medical Institutions and. Report H. 2011. Ministry of Health, Labour and Welfare.Google Scholar
  5. 5.
    Ri M, Miyata H, Aikou S, Seto Y, Akazawa K, Takeuchi M, Matsui Y, Konno H, Gotoh M, Mori M, Motomura N, Takamoto S, Sawa Y, Kuwano H, Kokudo N. Effects of body mass index (BMI) on surgical outcomes: a nationwide survey using a Japanese web-based database. Surg Today. 2015;45:1271–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin Y, Fu R, Grant E, Chen Y, Lee JE, Gupta PC, Ramadas K, Inoue M, Tsugane S, Gao YT, Tamakoshi A, Shu XO, Ozasa K, Tsuji I, Kakizaki M, Tanaka H, Chen CJ, Yoo KY, Ahn YO, Ahsan H, Pednekar MS, Sauvaget C, Sasazuki S, Yang G, Xiang YB, Ohishi W, Watanabe T, Nishino Y, Matsuo K, You SL, Park SK, Kim DH, Parvez F, Rolland B, McLerran D, Sinha R, Boffetta P, Zheng W, Thornquist M, Feng Z, Kang D, Potter JD. Association of body mass index and risk of death from pancreas cancer in Asians: findings from the Asia Cohort Consortium. Eur J Cancer Prev. 2013;22:244–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen YT, Deng Q, Che X, Zhang JW, Chen YH, Zhao DB, Tian YT, Zhang YW, Wang CF. Impact of body mass index on complications following pancreatectomy: Ten-year experience at National Cancer Center in China. World J Gastroenterol. 2015;21:7218–24.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Del Chiaro M, Rangelova E, Ansorge C, Blomberg J, Segersvard R. Impact of body mass index for patients undergoing pancreaticoduodenectomy. World J Gastrointest Pathophysiol. 2013;15:37–42.CrossRefGoogle Scholar
  11. 11.
    Angeles-Garay U, Morales-Márquez LI, Sandoval-Balanzarios MA, Velázquez-García JA, Maldonado-Torres L, Méndez-Cano AF. Risk factors related to surgical site infection in elective surgery. Cir. 2014;82:48–62.Google Scholar
  12. 12.
    Cho M, Kang J, Kim IK, Lee KY, Sohn SK. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei Med J. 2014;55:1611–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kristina A, Giles AD, Hamdan AD, Frank B, Pomposelli MC, Wyers JJ, Siracuse ML, Schermerhorn. Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005–2007. Ann Vasc Surg. 2010;24:48–56.CrossRefGoogle Scholar
  14. 14.
    Wändell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes (Lond). 2009;33:577–82.CrossRefGoogle Scholar
  15. 15.
    Ringbäck Weitoft G, Eliasson M, Rosén M. Underweight, overweight and obesity as risk factors for mortality and hospitalization. Scand J Public Helth. 2008;36:169–76.CrossRefGoogle Scholar
  16. 16.
    Seidell JC, Verschuren WM, van Leer EM, Kromhout D. Overweight, underweight, and mortality. A prospective study of 48,287 men and women. Arch Intern Med. 1996;156:958–63.CrossRefPubMedGoogle Scholar
  17. 17.
    Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E, Samet JM. Body-mass index and mortality in Korean men and women. N Engl J Med. 2006;355:779–87.CrossRefPubMedGoogle Scholar
  18. 18.
    Suemitsu R, Sakoguchi T, Morikawa K, Yamaguchi M, Tanaka H, Takeo S. Effect of body mass index on perioperative complications in thoracic surgery. Asian Cardiovasc Thorac Ann. 2008;16:463–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Davenport DL, Xenos ES, Hosokawa P, Radford J, Henderson WG, Endean ED. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg. 2009;49:140–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Suzuki S, Morishita K, Kaji S, Koike N, Harada N, Suzuki M, Imaizumi T. The change in pancreatic function following long-term survivors of curative resection for pancreatic cancer. Suizo. 2012;27:686–90.CrossRefGoogle Scholar
  21. 21.
    Hendifer A, Osipov A, Khanuja J, Nissen N, Naziri J, Yang W, Li Q, Tuli R. Influence of body mass index and albumin on perioperative morbidity and clinical outcomes in resected pancreatic adenocarcinoma. PLoS One. 2016;11:e0152172.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyKansai Medical University HospitalHirakataJapan
  2. 2.Department of Healthcare Economics and Quality Management, Graduate School of MedicineKyoto UniversityKyotoJapan
  3. 3.Department of SurgeryKansai Medical University HospitalOsakaJapan

Personalised recommendations