Preoperative weight loss and postoperative pancreatic fistula risk affected by body mass index: a National Surgical...

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.

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.

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.

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.