The Association of Body Mass Index with Postoperative Outcomes After Elective Paraesophageal Hernia Repair.

PURPOSE

To evaluate the association between body mass index (BMI) and postoperative outcomes in elective paraesophageal hernia (PEH) repairs.

METHODS

A retrospective review of patients who underwent elective PEH repair in the ACS NSQIP database (2005-2015) was performed. Patients were stratified into BMI groups (< 18.5, 18.5-24.9, 25.0-29.9, 30.0-34.9, 35-39.9, and ≥ 40.0 kg/m) according to the World Health Organization classification criteria. A multivariable logistic regression model was developed to characterize the association between BMI class and outcomes, including readmission, reoperation, postoperative complications, and mortality.

RESULTS

The median (IQR) age of the 9641 patients who met inclusion criteria was 64 (55-72) and 72.7% were women. Across each BMI class, age, race, gender, type of procedure, frailty index, smoking, and ASA class varied (p < 0.05). Underweight patients (BMI < 18.5 kg/m) had an increased risk of mortality (OR = 6.35, p < 0.05). Patients with a BMI 35-39.9 kg/m (OR = 0.65, p < 0.05) and ≥ 40 kg/m (OR = 0.36, p < 0.001) were associated with a decreased risk for readmissions.

CONCLUSION

Underweight patients have an increased risk for postoperative mortality after elective PEH repair. Higher BMI was associated with a diminished risk for readmission, but not for mortality, reoperations, or overall complications.