Effect of BMI on Operative Time in Patients Undergoing Distal Pancreatectomy

Background Preoperative body mass index (BMI) is known to impact surgical outcomes, but its effect on operative time in distal pancreatectomy (DP) remains unclear. This study hypothesizes that higher BMI is associated with prolonged operative time in DP, regardless of surgical approach. Methods A retrospective review of 48 patients who underwent DP, with or without splenectomy, at Advent Health Orlando in Orlando, Florida (October 2019-April 2024) was conducted. Patients were categorized by surgical approach: laparoscopic, robotic, robotic conversion to open (planned or unplanned), and open. Laparoscopic hand-assisted cases were excluded. Data included preoperative (age, sex, BMI, and American Society of Anesthesiologists (ASA) class) and intraoperative variables (operative time, splenectomy status, blood loss, conversion to open, and ICU admission). Pearson correlation and linear regression assessed BMI's impact on operative time. Results The mean BMI was 28.9 (range: 19.8-44.7), with 31.3% classified as obese (BMI ≥ 30). BMI correlated with longer operative time (r = 0.333, p = 0.021), although BMI categories (normal <25, overweight 25-30, obese >30) showed no significant difference (p = 0.24). Furthermore, this correlation persisted after controlling for surgical approach, tumor size, prior abdominal surgery, tumor location, ASA class, and concurrent splenectomy. BMI was not associated with conversion to open surgery, blood loss, or splenectomy rates. ICU admission was significantly associated with BMI when analyzed continuously (yes: 44.9 ± 7.6; no: 28.1 ± 5.5; p = 0.008), but not categorically (p = 0.22). Conclusion Higher BMI is significantly associated with increased operative time in DP, underscoring the need for preoperative planning in patients with elevated BMI. BMI as a continuous variable provides greater predictive value for surgical outcomes than categorical classification.