Published online Apr 28, 2017. doi: 10.4254/wjh.v9.i12.595
Peer-review started: December 5, 2016
First decision: January 21, 2017
Revised: February 15, 2017
Accepted: March 21, 2017
Article in press: March 22, 2017
Published online: April 28, 2017
To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver transplantation.
The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation (OLT) complications, and short term outcomes of OLT performed from 2003 to 2011 (n = 46509). We divided patients into those with [body mass index (BMI) ≥ 40] and without (BMI < 40) morbid obesity. Multivariable logistic regression analysis was performed to characterize differences in in-hospital mortality, length of stay (LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the results.
Of the 46509 patients who underwent OLT during the study period, 818 (1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female (46.8% vs 33.4%, P = 0.002), Caucasian (75.2% vs 67.8%, P = 0.002), in the low national income quartile (32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities (modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage (P = 0.028) and respiratory complications (P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality (OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS (β: -4.44; 95%CI: -9.93, 1.05, P = 0.11) and charges for transplantation (β: $15693; 95%CI: -51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays (81.7%) as compared to those without morbid obesity (75.4%, P = 0.029).
Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.
Core tip: Morbid obesity is a relative contraindication to orthotopic liver transplantation. Previous studies, mostly in the pre-MELD era, suggested worsened outcomes in these patients. As the prevalence of obesity continues to increase, so will the number of patients who are morbidly obese requiring liver transplantation. Utilizing the Nationwide Inpatient Sample which is the largest publicly available database in the United States, we did not find any difference in mortality, or healthcare utilization when comparing those with and without morbid obesity receiving liver transplantation. Our findings suggest that in highly selected patients, morbid obesity may not be a significant contraindication to transplantation.