Preoperative weight loss and postoperative pancreatic fistula risk affected by body mass index: a National Surgical Quality Improvement Program study

BACKGROUND: Postoperative pancreatic fistula (POPF) after pancreatectomy is associated with longer hospitalization, readmission, increased resource utilization, and early postoperative mortality. Preoperative weight loss has been identified as a significant predictor of adverse outcomes after gastrointestinal surgery. We studied the association between unintentional preoperative weight loss and POPF development after pancreatectomy.

METHODS: The National Surgical Quality Improvement Program database was retrospectively analyzed between 2014 and 2020. Patients with pancreatectomy and known fistula status were categorized by preoperative weight loss (>10% weight loss within 6 months) vs no preoperative weight loss. Interaction analyses between weight loss and preoperative body mass index (BMI) were used to analyze the effect on POPF risk.

RESULTS: Of 43 126 patients included in this study, 7017 (16.3%) developed POPF. Most patients were White (73.4%); were males (50.7%); had preoperatively healthy (33.2%), overweight (34.4%), or obese BMI (29.5%); and had an albumin level of ≥3.5 g/dL (71.0%). Preoperative weight loss was associated with lower odds of POPF (odds ratio [OR], 0.87; P <.001), whereas higher preoperative BMI increased odds of POPF (overweight [OR, 1.28], obese [OR, 1.78]; both P <.001). The interaction of weight loss and preoperative BMI on POPF development was significant (P =.012) with an increase of 1 point in BMI corresponding to a 67% increase in the odds of developing a fistula for patients who experienced weight loss and only a 4.3% increase for patients who did not.

CONCLUSION: Preoperative weight loss was associated with a lower incidence of POPF formation. Interaction analyses demonstrated that the impact of preoperative weight loss on POPF development varies with preoperative BMI.