Influence of obesity on in-hospital and postoperative outcomes of hepatic resection for malignancy: a 10-year retrospective analysis from the US National Inpatient Sample.
OBJECTIVES
The influence of obesity on the outcomes of curative liver resection for malignancies remains controversial. We aimed to compare the in-hospital outcomes of liver resection for malignancy between obese and non-obese patients.


DESIGN
This was a population-based, retrospective, observational study using data from the Nationwide Inpatient Sample (NIS), the largest all-payer US inpatient care database.


SETTING
Hospitalisations of adults ≥18 years old with diagnoses of primary hepatobiliary malignancy or secondary malignant neoplasms of liver in the USA were identified from the NIS database between 2005 and 2014.


PARTICIPANTS
Data of 18 398 patients ≥18 years old and underwent liver resection without pancreatic resection in the NIS were extracted. All included subjects had primary hepatobiliary malignancy or secondary malignant neoplasms of the liver. Patients were divided into obese and non-obese groups. These groups were compared with respect to postoperative complications, length of hospital stay and hospital cost according to surgical extent and approach.


INTERVENTIONS
Patients were undergoing lobectomy of liver or partial hepatectomy.


PRIMARY AND SECONDARY OUTCOME MEASURES
The primary endpoints of this study were postoperative complications, length of hospital stay and hospital cost.


RESULTS
After adjustment, obese patients were significantly more likely to experience postoperative complications than were non-obese patients (adjusted OR 1.25, 95% CI 1.10 to 1.42), regardless of whether lobectomy or partial hepatectomy was performed. Furthermore, obesity was significantly associated with increased risk of postoperative complications in patients who underwent open liver resection, but not laparoscopic resection. No significant difference was observed in length of hospital stay or total hospital costs between obese and non-obese patients.


CONCLUSIONS
After adjustment for preoperative comorbidities and other potential confounders, obesity is significantly associated with greater risk of complications in patients undergoing open liver resection for malignancy, but not laparoscopic resection.
['He|Jiafa|J|', 'Liu|Heping|H|', 'Deng|Li|L|', 'Wei|Xiangling|X|', 'Chen|Taiying|T|', 'Xia|Shangzhou|S|', 'Liu|Yubin|Y|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D006528:Carcinoma, Hepatocellular D016208:Databases, Factual D005260:Female D006498:Hepatectomy D017721:Hospital Costs D006801:Humans D007297:Inpatients D010535:Laparoscopy D007902:Length of Stay D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009765:Obesity D011183:Postoperative Complications D012189:Retrospective Studies D016896:Treatment Outcome D047368:Tumor Burden D014481:United States D055815:Young Adult
obese national inpatient sample open liver resection hepatocellular carcinoma (HCC) laparoscopic liver resection