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Impact of obesity on 30-day outcomes after laparoscopic colectomy
Amirbahador Abbasi1, Mingwen Jia1, Yuanyuan Ge1
1Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Background:
Obesity may influence perioperative outcomes after colectomy, but whether contemporary laparoscopic colectomy yields comparable short-term outcomes in obese and non-obese patients remains clinically relevant. This study compared 30-day outcomes between obese and non-obese patients undergoing laparoscopic colectomy and further examined conversion-related outcomes.
Methods:
Adult patients undergoing laparoscopic colectomy between 2014 and 2025 were identified from a prospectively maintained database. Obesity was defined as BMI ≥ 30 kg/m2. Demographic, preoperative, operative, and 30-day postoperative outcomes were compared by obesity status. Additional analyses evaluated conversion to open surgery, outcomes in converted versus non-converted patients, outcomes among converted patients by obesity status, multivariable predictors of readmission and reoperation, and BMI as a continuous variable.
Results:
Among 2,097 patients, 550 (26.2%) were obese and 1,547 (73.8%) were non-obese. Obese patients had longer operative time (median 175 vs. 164 min, P = 0.004) and higher 30-day readmission (11.8% vs. 8.8%, P = 0.04). There were no significant differences in reoperation (4.0% vs. 3.7%, P = 0.79), mortality (0.7% vs. 1.5%, P = 0.27), conversion to open surgery (11.3% vs. 10.3%, P = 0.51), or LOS (median 4 days in both groups, P = 0.74). Major complications, including anastomotic leak, abscess, and surgical site infection, were comparable. In multivariable analysis, obesity remained independently associated with readmission (OR 1.55, 95% CI 1.06-2.27, P = 0.02). Among converted patients, outcomes were comparable by obesity status. When BMI was analyzed continuously, increasing BMI was associated with anastomotic leak, but not with conversion, readmission, reoperation, mortality, abscess, ileus, or surgical site infection.
Conclusions:
Obesity was associated with longer operative time and higher readmission, but not with increased conversion, reoperation, mortality, LOS, or most postoperative complications. Laparoscopic colectomy can be performed with acceptable short-term outcomes in obese patients in an experienced center, although obesity remains relevant for readmission risk and possible BMI-associated leak risk.
