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/m2) 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/m2) had an increased risk of mortality (OR = 6.35, p < 0.05). Patients with a BMI 35-39.9 kg/m2 (OR = 0.65, p < 0.05) and ≥ 40 kg/m2 (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.