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Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy

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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.

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Authors and Affiliations

  1. Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, MC7400, La Jolla, CA, 92037-7400, USA

    James Jeffery Reeves & Ryan C. Broderick

  2. Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza suite 3325, Los Angeles, CA, 90095, USA

    Brittany N. Burton

  3. Department of Anesthesiology, University of California, San Diego, 9300 Campus Point Drive MC7770, La Jolla, CA, 92031-7770, USA

    Ruth S. Waterman & Rodney A. Gabriel

  4. Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Rodney A. Gabriel

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  1. James Jeffery Reeves
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  2. Brittany N. Burton
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  3. Ryan C. Broderick
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  4. Ruth S. Waterman
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  5. Rodney A. Gabriel
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Correspondence to James Jeffery Reeves.

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Drs. Reeves, Burton, Broderick, Waterman, and Gabriel have no conflicts of interest or financial ties to disclose.

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Reeves, J.J., Burton, B.N., Broderick, R.C. et al. Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy. Surg Endosc 35, 1348–1354 (2021). https://doi.org/10.1007/s00464-020-07514-7

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  • DOI: https://doi.org/10.1007/s00464-020-07514-7

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