Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk

Background: We evaluated perioperative outcomes in super obese patients (body mass index >50 kg/m²) undergoing liver resection using the American College of Surgeons National Surgical Quality Improvement Program. Methods: Patients undergoing hepatectomy recorded in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2015 were analyzed. Out of 21,228 hepatectomies in the National Surgical Quality Improvement Program dataset, 146 were performed on super obese patients. Results: Seventy-two percent of the super obese patients were female with a median age of 50.6 years, and 10% were classified as American College of Surgeons Class ≥III. In this group, 69.2% were hypertensive, 38.4% were diabetics, and 17.8% had dyspnea. The median operation time was 248 minutes in the super obese group, greater than any other body mass index class. Twenty-two percent of these patients required perioperative transfusion, although 74% underwent partial hepatectomies. Body mass index >50 kg/m² significantly increased morbidity in patients undergoing hepatectomies, almost 2-fold. Infectious complications increased by 86%, and the risk of developing critical care complications increased by 63%. Conclusion: Our data show that super obesity (body mass index >50 kg/m²) is the strongest independent predictor of perioperative morbidity. These patients also are at much greater risk of infectious complications and critical care complications. Future studies should be conducted using weight loss strategies in extreme obese patients to reduce their risk of life-threatening complications after hepatectomy.